Simple SummaryThe large perineal defect, with impaired wound healing and delayed start of the adjuvant chemotherapy, can make the reconstructive phase of abdominoperineal resection for low rectal cancer extremely challenging. Using biosynthetic mesh for the neo-perineum reconstruction after a Miles’ procedure is a poorly investigated technique, which, in our series, resulted in safe, reproducible results affected by limited complications. Moreover, for improved perineal wound healing, it guaranteed a faster start of the adjuvant therapy with clear reduction in oncological outcomes (i.e., recurrences and death).AbstractBackground: Local wound complications are among the most relevant sequelae after an abdominoperineal resection (APR) for low rectal cancer. One of the proposed techniques to improve the postoperative recovery and to accelerate the initiation of adjuvant chemotherapy is the mesh reinforcement of the perineal wound. The aim of the current study is to compare the surgical and oncological outcomes after APR performed with a biosynthetic mesh reconstruction versus the conventional procedure. Methods: From 2015 to 2020, in two tertiary centres, the surgical outcomes, the wound events (i.e., surgical site infections, wound dehiscence and the complete healing time) and the oncological outcomes (i.e., time length to start adjuvant chemo-radiotherapy, an over 8-week delay in chemotherapy and the recurrence rate) were retrospectively analysed in patients undergoing APR reinforced with biosynthetic mesh (Group A) and conventional APR (Group B). Results Sixty-one patients were treated with APR (25 in Group A and 36 in Group B). Patients in Group A presented lower time for: healing (16 versus 24 days,p= 0.015), inferior perineal wound dehiscence rates (one versus nine cases,p= 0.033), an earlier adjuvant therapy start (26 versus 70 days,p= 0.003) and a lower recurrence rate (16.6% vs. 33.3%,p= 0.152). Conclusions: In our series, the use of a biosynthetic mesh for the neo-perineum reconstruction after a Miles’ procedure has resulted in safe, reproducible results affected by limited complications, guarantying a rapid start of the adjuvant therapy with clear benefits in oncological outcomes. Further randomized clinical trials with long-term follow-up are needed to validate these results.