Predictive Factors of Difficulty during Laparoscopic Total Mesorectal Excision in Rectal Cancer

Abstract

Background:Despite the fact that laparoscopic resection is considered a standard technique in colon cancer, its role in rectal cancer is still under research. Total mesorectal excision allows en bloc removal of the mesorectum with the rectal fascia and decreases the recurrence rate to 5%. The aim of the study was to evaluate the factors predicting difficulty of the laparoscopic total mesorectal excision in anorectal cancer.

Patient and Methods:Twenty-four patients were included in the study. Laparoscopic total mesorectal excision was done in all patients. Gender, body massindex, tumor diameter, tumor distance from the anal verge, preoperative chemotherapy, and 5 pelvic dimensions (pelvic inlet, pelvic outlet, length of sacrum, interspinous distance, and intertuberous distance) were analyzed as variables affecting the difficulties of laparoscopic TME.

Results:Multivariate analysis showed that BMI (P<0.0001), tumor distance from the anal verge
(P=0.0003), tumor depth (P=0.0021), and pelvic outlet (P=0.0362) were independently predictive of
pelvic operative time. Pelvic operative time was related to intraoperative blood loss (P<0.0001). The
tumor distance from the anal verge (P=0.0333, odds ratio 1.06) was related to postoperative
morbidity, and pelvic outlet was related to anastomotic leakage (P=0.0305, OR: 1.13).

Conclusion:Higher BMI, shorter distance from anal verge and narrow pelvic outlet are predictive factors of longer operative time in laparoscopic TME.