Using biological mesh for pelvic floor reconstruction after extralevator abdominoperineal resection in low rectal cancer patients does not provide a cost-effective solution despite slightly reducing perineal complications.

• Pelvic reconstruction with biological mesh increased costs (€57,991) versus primary closure (€56,232) without significant improvement in long-term patient outcomes or quality of life.
• The study’s conclusions suggest routine use of biological mesh is not justified from a cost-effectiveness standpoint.

Surgeons should carefully consider the financial and clinical implications of using biological mesh in this context.