Factors Predicting Difficulty of Laparoscopic Low Anterior Resection for Rectal Cancer with Total Mesorectal Excision and Double Stapling Technique

Chen, Weiping; Li, Qiken; Fan, Yong; Li, Dechuan; Jiang, Lai; Qiu, Pengnian; Tang, Lilong

doi:10.1371/journal.pone.0151773

Cited by 19 publications

(18 citation statements)

References 30 publications

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“…However, numerous studies report quite different operative times,9,12,14,15,21 which will make it impossible to directly pool these data. We have introduced the standardized operative time which indirectly indicates the percentile of operative difficulty 17. This novel standardized endpoint enables to researchers to enlarge sample sizes by pooling data from published studies, and built reliable predicting models for clinical use.…”

Section: Discussionmentioning

confidence: 99%

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

Jiang

et al. 2017

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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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.

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Section: Discussionmentioning

confidence: 99%

“…Data transformation by square root was applied to the operative time and blood loss during surgery, to meet the normality requirement. Operative time and blood loss were standardized by minusing their mean and then dividing by their SD 17. Student t test or χ 2 test was applied to examine the difference of each variable as indicated.…”

Section: Methodsmentioning

confidence: 99%

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

Jiang

et al. 2017

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Besides surgical skills, there are several well-established factors associated with the increased surgical difficulty of LaTME, including male sex, high body mass index (BMI), prior abdominal surgery, a low-lying tumor, and advanced tumor stage [ 10 , 11 ]. The pelvic anatomy can also influence the operative difficulties of LaTME, including—but not limited to—a prominent sacral promontory, an acutely curved sacrum, or a narrow pelvic outlet.…”

Section: Introductionmentioning

confidence: 99%

MRI pelvimetry-based evaluation of surgical difficulty in laparoscopic total mesorectal excision after neoadjuvant chemoradiation for male rectal cancer

et al. 2021

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Purpose Laparoscopic total mesorectal excision (LaTME) is technically demanding in rectal cancer after neoadjuvant chemoradiotherapy (NCRT). This study aimed to predict the surgical difficulty of LaTME after NCRT based on pelvimetric parameters. Methods This study enrolled 147 patients who underwent LaTME after NCRT. The surgical difficulty was graded as high or low according to the operative time, estimated blood loss, conversion to open surgery, postoperative hospital stay, and postoperative complications. Pelvimetry parameters were collected based on preoperative MRI. A logistic regression analysis was performed to identify predictors of high surgical difficulty, and a nomogram was developed. Results Totally, 18 (12.2%) patients were graded as high surgical difficulty. High surgical difficulty was correlated with a shorter interspinous distance (P = 0.014), a small angle α and γ (P = 0.008, P = 0.008, respectively), and a larger mesorectal area and mesorectal fat area (P = 0.041, P = 0.046, respectively). Tumor distance from the anal verge (OR = 0.619, P = 0.024), tumor diameter (OR = 3.747, P = 0.004), interspinous distance (OR = 0.127, P = 0.007), and angle α (OR = 0.821, P = 0.039) were independent predictors of high surgical difficulty. A predictive nomogram was developed with a C-index of 0.867. Conclusion A shorter tumor distance from the anal verge, larger tumor diameter, shorter interspinous distance, and smaller angle α could help to predict high surgical difficulty of LaTME in male LARC patients after NCRT.

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“…Other factors unique to cancer patients include the potential for prior therapies related to their cancer care, such as surgical procedures or neo-adjuvant chemo-radiation which can affect the tissue quality or cause adhesions making the dissection more challenging and may contribute to lengthier ORTs and greater hospital resource use [13]. …”

Section: Discussionmentioning

confidence: 99%

“…The greater hospital resource use, costs, and complication rates associated with oncologic surgical resections relative to benign indications could be attributed to several differences in the surgical techniques required, extended tissue resection for adequate margins, lymph node dissection for staging, and/or the resection of ancillary tissues [ 13 – 15 ]. Other factors unique to cancer patients include the potential for prior therapies related to their cancer care, such as surgical procedures or neo-adjuvant chemo-radiation which can affect the tissue quality or cause adhesions making the dissection more challenging and may contribute to lengthier ORTs and greater hospital resource use [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Economic burden of cancer among patients with surgical resections of the lung, rectum, liver and uterus: results from a US hospital database claims analysis

Kalsekar

Hsiao²,

Cheng³

et al. 2017

Health Econ Rev

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ObjectivesTo determine hospital resource utilization, associated costs and the risk of complications during hospitalization for four types of surgical resections and to estimate the incremental burden among patients with cancer compared to those without cancer.MethodsPatients (≥18 years old) were identified from the Premier Research Database of US hospitals if they had any of the following types of elective surgical resections between 1/2008 and 12/2014: lung lobectomy, lower anterior resection of the rectum (LAR), liver wedge resection, or total hysterectomy. Cancer status was determined based on ICD-9-CM diagnosis codes. Operating room time (ORT), length of stay (LOS), and total hospital costs, as well as frequency of bleeding and infections during hospitalization were evaluated. The impact of cancer status on outcomes (from a hospital perspective) was evaluated using multivariable generalized estimating equation models; analyses were conducted separately for each resection type.ResultsAmong the identified patients who underwent surgical resection, 23 858 (87.9% with cancer) underwent lung lobectomy, 13 522 (63.8% with cancer) underwent LAR, 2916 (30.0% with cancer) underwent liver wedge resection and 225 075 (11.3% with cancer) underwent total hysterectomy. After adjusting for patient, procedural, and hospital characteristics, mean ORT, LOS, and hospital cost were statistically higher by 3.2%, 8.2%, and 9.2%, respectively for patients with cancer vs. no cancer who underwent lung lobectomy; statistically higher by 6.9%, 9.4%, and 9.6%, respectively for patients with cancer vs. no cancer who underwent LAR; statistically higher by 4.9%, 14.8%, and 15.7%, respectively for patients with cancer vs. no cancer who underwent liver wedge resection; and statistically higher by 16.0%, 27.4%, and 31.3%, respectively for patients with cancer vs. no cancer who underwent total hysterectomy. Among patients who underwent each type of resection, risks for bleeding and infection were generally higher among patients with cancer as compared to those without cancer.ConclusionsIn this analysis, we found that patients who underwent lung lobectomy, lower anterior resection of the rectum (LAR), liver wedge resection or total hysterectomy for a cancer indication have significantly increased hospital resource utilization compared to these same surgeries for benign indications.

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Factors Predicting Difficulty of Laparoscopic Low Anterior Resection for Rectal Cancer with Total Mesorectal Excision and Double Stapling Technique

Cited by 19 publications

References 30 publications

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

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

MRI pelvimetry-based evaluation of surgical difficulty in laparoscopic total mesorectal excision after neoadjuvant chemoradiation for male rectal cancer

Economic burden of cancer among patients with surgical resections of the lung, rectum, liver and uterus: results from a US hospital database claims analysis

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