OBJECTIVE: To investigate the clinical effect of laparoscopic Miles operation for low rectal cancer. Methods: A total of 120 patients underwent Miles for low rectal cancer, including 50 cases in the laparoscopic group: Miles for low rectal cancer was performed laparoscopically following the principles of TME; 70 cases in the open group: conventional open surgery was performed. The status of perioperative period, number of lymph node dissection and hospitalization time were compared between the two groups. RESULTS: The rectal mesentery of the resected specimens was intact in both groups, and there was no intermediate open abdomen in the laparoscopic group. In comparison between the two groups, the laparoscopic group took longer time, but the patients had faster postoperative bowel function recovery [(39.5 ± 28.5 h) vs. (52.4 ± 12.2 h), P<0.05] and shorter hospital stay [(11.0 ± 5.4 d) vs. (14.6 ± 4.1 d), P<0.05]. The amount of intraoperative bleeding was comparable to the number of lymph nodes cleared. There were no postoperative patient deaths and no pelvic recurrence or metastases from punctured tract implants. CONCLUSION: Miles surgery for low rectal cancer performed via laparoscopy is effective and has the advantages of less trauma and faster recovery. Since Jacobs and Fowler completed laparoscopic right hemicolectomy and sigmoid resection in 1990 [1,2], laparoscopy has accumulated several years of experience in colorectal surgery with satisfactory minimally invasive results [3-5]. In our hospital, 50 cases of laparoscopic Miles were performed from January 2007 to December 2010, and the results were satisfactory when compared with 70 cases of open Miles in the same period. The results are reported as follows: I. Clinical data and methods 1. Clinical data (1) General data, from January 2007 to December 2010. There were 120 cases of low rectal cancer and anal canal cancer in our hospital, the cancer was 2-5 cm from the anal verge, and the diagnosis was confirmed by anal finger examination and pathological examination by colorectal microscopy, and no distant organ metastases such as lung and liver were found by CT examination before surgery. 43 cases were in Dukes stage A, 46 cases in stage B, and 31 cases in stage C. Pathological types: 55 cases of highly differentiated adenocarcinoma, 44 cases of moderately differentiated adenocarcinoma, and 21 cases of hypofractionated adenocarcinoma. Among them, 50 cases underwent laparoscopic Miles and 70 cases underwent open Miles. The comparison of the preoperative conditions of the two groups was comparable. All surgeries were performed by the same group. 2. Methods Both groups were performed according to the principles of total rectal mesenteric excision (TME). The open group was routinely performed under general anesthesia. In the laparoscopic group, the same anesthesia was used, and the patient was placed in a head-low-foot-high lithotomy position, and the operating table was adjusted according to the operating field so that the small intestine moved upward by gravity and the operating field was well exposed, and the operator was located on the right side of the patient. A 10-mm observation hole was made at the superior umbilical rim, and a C02 pneumoperitoneum was established by puncture with a pressure setting of 13-15 mmHg. 12-mm trocar was placed at the left and right anterior superior iliac spine and the outer 1/3 of the umbilical foramen, and a 5-mm trocar was placed 5 cm to the right of the umbilicus, and routine exploration was performed to determine whether there were metastases and abdominal implants in the intra-abdominal organs. A colostomy port was prepared in the outer 1/3 of the line between the umbilicus and the left anterior superior iliac spine, and the operation was strictly performed without tumor. The entire operation was performed with ultrasonic knife. The plasma membrane layer of the root of the inferior mesenteric artery was incised first to remove the fat and lymph nodes around the vessel to "skeletonize" it, and after skeletonization, the inferior mesenteric artery and vein were clamped and dissected separately with vascular clips. The right and left peritoneum of the sigmoid colon was incised, up to the descending colon and down to the anterior peritoneal reflex of the rectum. Traction was applied to the sigmoid colon to put some tension on the mesentery, and the posterior peritoneum was incised in front of the abdominal aorta according to the TME method, and the inferior mesenteric artery and accompanying veins were cut free, and the mesentery of the sigmoid colon was separated from the inside to the outside, and the adipose tissue in front of the left common iliac artery was peeled off, taking care not to damage the bilateral ureters. The left posterior peritoneum of the sigmoid colon was incised, and the sigmoid mesentery was freed from the posterior peritoneal wall. The rectum was removed along the gap between the intrinsic rectal fascia and the pelvic wall, the posterior part of the rectum was separated to both sides and the lateral rectal ligaments were cut off, the rectum was removed downward near the pelvic wall, the fatty lymphatic tissue of the pelvic wall on both sides was removed, the tip of the tailbone and the plane of the anal levator muscle on both sides were reached downward, and the anterior wall of the rectum was separated to the plane of the prostate tip. During surgery, attention was paid to protecting the pelvic plexus and sacral plexus. Depending on the diameter of the sigmoid colon, the perforation hole in the left lower abdomen was enlarged appropriately, and the proximal sigmoid colon was raised through this hole to perform a single-lumen fistula, and the fistula was opened in one stage. In the perineal group, the anorectal ligament was severed anteriorly through the tip of the tailbone, the anal levator muscle was separated and severed on both sides near the pelvic wall, the anal canal was pulled forward, the anal levator fascia was incised transversely, the posterior presacral space was entered, the anal levator fascia was cut and enlarged on both sides, and the free severed sigmoid colon and rectum were pulled out from the presacral area. The deep forward crossing fibers of the external anal sphincter are cut, and the index finger and middle finger are inserted into the pelvis between the prostate (posterior vaginal wall) and the rectum, and the attached muscles in front of the rectum are cut and the rectum is removed. When separating the anterior rectal wall, prevent damage to the urethra and posterior vaginal wall, and pay attention to avoid contamination of the wound by penetration of the anterior rectal wall. After the specimen was removed from the perineal incision, the pelvic cavity and the puncture hole were irrigated with 1,500-2,000 mL of warm distilled water and chlorhexidine solution, and the bleeding was thoroughly stopped after aspiration, and the perineal incision was sutured layer by layer, and the pelvic floor peritoneum was not sutured in the laparoscopic group (the pelvic floor peritoneum was sutured in the open group), and a silicone drainage tube was left in the pre-sacral pelvic cavity and drained from the perineal incision by another poke hole. 3. The operating time, intraoperative bleeding, postoperative intestinal function recovery, postoperative hospitalization time, number of lymph node dissection, intestinal obstruction, abdominopelvic infection, stoma necrosis, retraction, bleeding, paracentral hernia, stenosis, incisional infection, incisional and perforator tumor implantation and pelvic recurrence, and other complications were recorded at present. 4. Statistical processing was performed using SPSS 13.0 statistical software, and the measurement data were expressed as ±s. The comparison of means was performed using t-test, and P<0.05 was considered a statistically significant difference. There were no surgical deaths in both groups, no intraoperative rectal perforations, no ureteral and adjacent organ injuries, and no presacral hemorrhage. The rectal mesentery of the removed specimens was intact. The operative time, intraoperative bleeding, postoperative intestinal function recovery, postoperative hospital stay, and the number of lymph node dissection in both groups are shown in the attached table. There was no intermediate open abdomen in 50 patients in the laparoscopic group, and 70 patients in the open group had postoperative urinary retention in l cases. In both groups, there was no intestinal obstruction, no abdominopelvic infection, no stoma necrosis, retraction, bleeding, paracentral hernia, stricture, or incisional infection, and no cases of incisional and perforator tumor implantation and pelvic recurrence were found at 6-12 months of follow-up. Lacy has compared the data of patients undergoing laparoscopic and open surgery and found that the recurrence and survival rates of the laparoscopic group were even better than those of the open group [6]. Wu Wenxi et al. have also reported that laparoscopic surgery has fewer postoperative complications than conventional surgery, such as intestinal adhesions, incisional infections, and a significantly lower incidence of damage to surrounding organs than conventional open surgery, and that patients suffer less pain and less postoperative pain medication [7]. The suppression of immune system function by conventional open surgery leads to a decrease in the body's immunity to tumor cells, which plays an important role in preventing tumor recurrence and metastatic spread, and laparoscopic surgery has no significant immune depression [8]. Compared with open surgery, laparoscopic surgery for rectal cancer Miles reduces the abdominal surgical incision, reduces trauma and also reduces the time of organ exposure and reduces the loss of abdominal fluid, which facilitates the maintenance of fluid balance and facilitates postoperative recovery. Because of the magnification effect of laparoscopy, the field of view is clearer, which facilitates precise operation, such as the clearance of lymph nodes in the operative field, and better ensures the thoroughness of the operation. Due to the special view of the laparoscope, it can select the human path to the pelvic fascial wall layer more precisely and can better free the anterior and bilateral walls of the rectum; the magnification of the local surgical field is more conducive to the protection of the pelvic plexus [9]. In addition, due to the absence of an abdominal incision, patients do not have increased pulmonary complications due to incisional pain affecting postoperative coughing and sputum evacuation. In this study, the intraoperative bleeding was comparable between the two groups due to the use of ultrasonic knife throughout the open surgery in the surgical group, while the laparoscopic group had earlier recovery of bowel function and shorter postoperative hospital stay than the open group, fully demonstrating the advantages of laparoscopic Miles procedure. During the laparoscopic operation, the closure and dissociation of the sigmoid colon tube with a wire cutter ensured a tumor-free operation also reducing the chance of abdominal contamination. During the study time, no intestinal obstruction or abdominopelvic infection occurred after laparoscopic operation, and there was no stoma necrosis, retraction, bleeding, paracentral hernia, stricture, and no incisional infection or tumor implantation and pelvic recurrence in the incisional and punctal tracts, and the incidence of postoperative urinary retention and other complications were low. Theoretically, there should be a difference as the number of cases in the study increases and there should be fewer complications in the laparoscopic group. In this group, the laparoscopic group took longer than the open group, mainly because of the time-consuming separation of the root of the submesenteric vessels and, in addition, because of the poor separation of the two sides of the rectum at the pelvic floor during the initial operation in the laparoscopic group and the time-consuming removal of the rectum from the perineum. As the laparoscopic technique becomes more proficient, the time consumed by the two groups will be more similar. Laparoscopic Miles surgery for rectal cancer has all the advantages of minimally invasive surgery, and the absence of traditional incisions in the abdomen reduces not only the physical pain but also the mental anguish suffered by the patient. Although laparoscopic colorectal surgery has its advantages and is safe and feasible, the surgeon's proficiency in laparoscopic surgery and extensive experience in open surgery are prerequisites for this type of surgery.