Factors Influencing Difficulty of Laparoscopic Abdominoperineal Resection for Ultra-Low Rectal Cancer

Abstract

Purpose:Our current study was conducted to identify patients’ anatomic, pathologic, and clinical factors to predict difficulty of performing laparoscopic abdominoperineal resection for ultra-low rectal cancer.Materials and Methods:Records of 117 consecutive patients with rectal cancer 2 to 5 cm from the anal verge were retrospectively reviewed. Using univariate and multivariate linear or logistic regression models, standardized operative time and blood loss, as well as postoperative morbidity were utilized as endpoints to screen patients’ multiple variables to predict operative difficulty.Results:Multivariate linear regression analysis showed body mass index (BMI) (estimate=0.07, P=0.0056), interspinous distance (estimate=−0.02, P=0.0011), tumor distance from anal verge (estimate=−0.17, P=0.0355), prior abdominal surgery (estimate=0.51, P=0.0180), preoperative chemoradiotherapy (estimate=0.67, P=0.0146), and concurrent diseases (hypertension and/or diabetes mellitus) (estimate=0.49, P=0.0122) are predictors for standardized operative time. Age (estimate=0.02, P=0.0208) and concurrent diseases (estimate=0.43, P=0.0476) were factors related to standardized blood loss. BMI (estimate=0.15, P=0.0472) was the only predictor for postoperative morbidity based on logistic regression analysis.Conclusions:Age, BMI, interspinous distance, tumor distance from anal verge, prior abdominal surgery, preoperative chemoradiotherapy, and concurrent diseases influence the difficulty of performing laparoscopic abdominoperineal resection for ultra-low rectal cancer. Standardized operative time allows researchers to amass samples by pooling data from all published studies, thus building reliable models to predict operative difficulty for clinical use.

Assessing surgical difficulty in locally advanced mid–low rectal cancer: the accuracy of two MRI‐based predictive scores

“…In the literature, other MRI‐based studies identified patient‐ and tumour‐related predictors of surgical difficulty . Most of them found an association between male sex and risk of conversion from laparoscopy to laparotomy , or greater tumour volume with longer operative times .…”

Increased body mass index is associated with operative difficulty during robot‐assisted radical prostatectomy

“…15,18,19 In the current literature, operative time and EBL are often used as surrogate markers for surgical difficulty without directly assessing surgeon-reported difficulty. [4][5][6][7][8][9] We demonstrate that EBL and opera- 20 Previous studies of laparoscopic and robotic surgery have demonstrated that pelvic measurements may impact the difficulty of pelvic surgery due to limited working space. [4][5][6][7]11,21 Using measurements including transverse pelvic diameter as well as the prostate volume:…”

“…[4][5][6][7][8][9] We demonstrate that EBL and opera- 20 Previous studies of laparoscopic and robotic surgery have demonstrated that pelvic measurements may impact the difficulty of pelvic surgery due to limited working space. [4][5][6][7]11,21 Using measurements including transverse pelvic diameter as well as the prostate volume:…”

“…Previous studies frequently use surrogate measures of surgical complexity such as estimated blood loss (EBL) or operative time, without directly evaluating surgeon feedback on the case complexity. [4][5][6][7][8][9] This study aimed to identify factors that are associated with a surgeon's perception of increased RARP difficulty. We hypothesized that anatomic factors such as body mass index (BMI) and the pelvic diameter would impact surgeon perception of difficulty.…”

Prediction of surgical difficulty in minimally invasive surgery for rectal cancer by use of MRI pelvimetry

“…Previous studies identified several variables to predict the difficulty of rectal resections. Sex, BMI, tumour size and location, nCRT and co‐morbidity, anastomotic height, histopathological features, surgeon experience and anatomical dimensions of the pelvis were reported to be risk factors for conversion to open surgery, duration of surgery, CRM positivity and postoperative morbidity. Several MRI pelvimetric parameters have been investigated previously; however, the results were inconsistent owing to differences in sample size, the racial composition of patient populations, variables measured, and definitions of surgical difficulty used across studies.…”