[Abstract] Objective To investigate the relationship between the integrity of rectal mesentery and postoperative recurrence during radical rectal cancer surgery. Methods We used total rectal mesenteric resection for rectal cancer to treat 75 cases of low and middle rectal cancer (treatment group), and also retrospectively analyzed 75 cases of low and middle rectal cancer treated by conventional radical rectal cancer in our hospital (control). Conclusion The use of total rectal mesorectal resection for rectal cancer can effectively reduce the postoperative recurrence rate and improve the survival rate, which is worth promoting in the clinic. [Keywords] Radical rectal cancer; rectal mesentery; integrity; postoperative recurrence The recurrence rate of rectal cancer after surgical treatment is high, which seriously affects the survival quality of patients. Recently, total rectal mesenteric resection for rectal cancer is increasingly used in rectal cancer surgery. This surgical method can effectively reduce the local recurrence rate and postoperative metastasis of low rectal cancer, reduce the postoperative mortality rate of rectal cancer patients, and improve the 5-year survival rate of rectal cancer patients after surgery. The author used total rectal mesenteric resection for rectal cancer to treat 75 cases of low rectal cancer, which significantly reduced the postoperative recurrence rate of radical rectal cancer and achieved satisfactory results, which are summarized as follows. 1. Information and methods 1.1 General information All 75 cases were rectal cancer patients treated by total rectal mesenteric resection in our hospital from May 2008 to October 2011 as the treatment group. Among them, 51 cases were male and 24 cases were female; age ranged from 25 to 68 years old, with an average of 51.3±18.5 years old. All patients were confirmed to have rectal cancer by proctoscopy and histopathological biopsy before surgery; tumor types were: 23 cases (30.67%) of highly differentiated adenocarcinoma, 19 cases (25.33%) of moderately differentiated adenocarcinoma, 15 cases (20.00%) of highly differentiated adenocarcinoma, 5 cases (6.67%) of papillary adenocarcinoma, 7 cases (9.33%) of indolent cell carcinoma, and 6 cases (8.00%) of mucinous cell carcinoma ); Dukes’ stage was 33 patients with stage A, 25 patients with stage B, and 17 patients with stage C. We also retrospectively analyzed the clinical data of 75 patients with rectal cancer treated by conventional radical rectal cancer in our hospital before May 2008 as the control group, of whom 49 were male and 26 were female; age ranged from 23 to 70 years old, with an average of 52.4±18.6 years. There were no significant differences between the two groups in terms of gender, age and pathological stage, which were comparable (P＞0.05). 1.2 Surgical method Patients in the control group were given continuous epidural anesthesia, and the rectal cancer site was explored by median incision in the lower abdomen, and cancerous tissues were found and then removed, and intraoperative lymph node dissection was performed, the skin was closed layer by layer, drains were left in place, and antibiotics were applied routinely. Patients in the treatment group were placed in a lithotomy position and anesthetized by endotracheal intubation. A median incision was made in the abdomen, and the rectum and abdominal cavity were explored after entering the abdomen. After deciding the scope of surgical resection according to the rectal cancer, the proximal bowel lumen was ligated, and then all the submesenteric vessels were ligated at a high level. The rectum and the surrounding loose connective tissue were freed with an electric knife, and the posterior wall of the rectum was freed backward to the tip of the tailbone, preserving the inferior abdominal nerve during the freeing process and paying attention to the integrity of the “mesenteric parcel”, and then the rectal mesentery and pelvic nerve were freed with an electric knife. If the patient is found to have a middle rectal artery, it is necessary to stop the bleeding in advance, cut the pelvic floor peritoneum in front, and continue to use the electric knife to sharply free the anterior wall of the rectum until 2-5 cm below the mass, and keep the integrity of Denonvillie’s fascia, at this time, the rectum and its mesentery are completely free, and at a distance of 2-5 cm from the rectal cancer lesion At this point, the rectum and its mesentery were completely free, and the rectum was completely dissected at 2-5 cm from the lower edge of the rectal cancer lesion. After complete resection of the tumor specimen, it was flushed with a large amount of distilled water and a mixture of 5-FU. The rectum and descending colon were anastomosed end to end (double anastomosis). When the length of the proximal colon was not long enough after resection, the splenic flexure portion of the free colon was chosen for the extension of the rectum to normalize the anastomotic tension. After the anastomosis was completed, the incision was closed layer by layer, drainage tubes were left in place, and antibiotics were routinely used after the operation. 1.3 Observation indexes Postoperative recurrence rate and postoperative survival rate of patients in both groups. 1.4 Statistical methods SPSS17.0 software was used for the statistical and analysis of data. t-test was used for data information, X2 test was used for comparison between groups, and P < 0.05 was considered as a statistically significant difference. 2. Results There were 7 cases of postoperative rectal cancer recurrence in the treatment group, with a recurrence rate of 9.33%, and 19 cases of postoperative rectal cancer recurrence in the control group, with a recurrence rate of 25.33%, and the postoperative recurrence rate of patients in the treatment group was significantly lower than that of the control group (P < 0.05). In the postoperative treatment group, the survival rates of the control group and patients at 1 and 2 years after surgery were 71/74 (95.95%) and 69/71 (97.18%), respectively, and the survival rates of the control group patients at 1 and 2 years after surgery were 67/73 (91.78%) and 68/67 (86.57%), respectively, and the survival rates of the treated patients at 2 years after surgery were significantly lower than those of the control group (P < 0.05), but there was no significant difference in the survival rate at 1 year postoperatively (>0.05). Table 1 Comparison of postoperative recurrence rate and survival rate between the two groups (n/%) Group Number of cases Postoperative recurrence rate 1-year survival rate 2-year survival rate Treatment group 75 7 (9.33) 71/74 (95.95) 69/71 (97.18) Control group 75 19 (25.33) 67/73 (91.78) 58/67 (86.57)