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Ahn JS, Park J, Ryoo SB, Kim MJ, Park JW, Jeong SY, Park KJ. Safety and efficacy of flexible articulated instrument (ArtiSential ®) in laparoscopic surgery for rectal cancer. BMC Surg 2025; 25:192. [PMID: 40312374 PMCID: PMC12046734 DOI: 10.1186/s12893-025-02841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 03/12/2025] [Indexed: 05/03/2025] Open
Abstract
BACKGROUND Laparoscopic surgery for rectal cancer remains challenging because of limited joint motion during dissection in the deep and narrow pelvis. Handheld multiarticulated instruments have been developed to address these limitations. This study aimed to assess the safety and efficacy of a flexible articulated instrument, the ArtiSential® (Livsmed Co, Korea), at reducing the duration of laparoscopic rectal cancer surgery. STUDY DESIGN We retrospectively reviewed patients who underwent laparoscopic low or ultralow anterior resection for primary mid to low rectal cancer (tumor distance from anal verge, ≤ 10 cm) performed by a single surgeon in 2012-2022. Patients were divided into groups based on the use of ArtiSential® or straight device, and their clinical characteristics, surgical procedures, pathological findings, postoperative complications, and survival outcomes were analyzed. RESULTS The study included 93 patients (articulating group, 32; straight group, 61). Low anterior resection was predominant in both groups, while operative time was significantly shorter in the articulating group (148.08 ± 49.72 vs. 188.13 ± 57.86; p = 0.003). Total mesorectal excision quality and resection margin status did not differ between groups. Postoperative complications, including anastomotic leakage, length of hospital stay, 3-year recurrence-free survival rate (90.6% vs. 88.5%, p = 0.760), and overall survival rate (100% vs. 85.2%, p = 0.092), did not differ between groups. CONCLUSION Use of the flexible articulated instrument (ArtiSential®) can reduce operative time without impairing surgical quality or oncologic outcomes. These results suggest that laparoscopic rectal cancer surgery can be performed safely and effectively using a flexible articulated instrument. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Jong-Sung Ahn
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jesung Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
- Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Korea.
- Cancer Research Institute, Seoul National University, Seoul, Korea.
- Division of Colorectal Surgery, Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro (28 Yongon-dong), Jongro-gu, Seoul, 03080, Korea.
| | - Min-Jung Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Ji-Won Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Kyu-Joo Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Zhou XC, Guan SW, Ke FY, Dhamija G, Wang Q, Chen BF. Construction of a nomogram model to predict technical difficulty in performing laparoscopic sphincter-preserving radical resection for rectal cancer. World J Gastroenterol 2024; 30:2418-2439. [PMID: 38764764 PMCID: PMC11099392 DOI: 10.3748/wjg.v30.i18.2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/06/2024] [Accepted: 04/17/2024] [Indexed: 05/11/2024] Open
Abstract
BACKGROUND Colorectal surgeons are well aware that performing surgery for rectal cancer becomes more challenging in obese patients with narrow and deep pelvic cavities. Therefore, it is essential for colorectal surgeons to have a comprehensive understanding of pelvic structure prior to surgery and anticipate potential surgical difficulties. AIM To evaluate predictive parameters for technical challenges encountered during laparoscopic radical sphincter-preserving surgery for rectal cancer. METHODS We retrospectively gathered data from 162 consecutive patients who underwent laparoscopic radical sphincter-preserving surgery for rectal cancer. Three-dimensional reconstruction of pelvic bone and soft tissue parameters was conducted using computed tomography (CT) scans. Operative difficulty was categorized as either high or low, and multivariate logistic regression analysis was employed to identify predictors of operative difficulty, ultimately creating a nomogram. RESULTS Out of 162 patients, 21 (13.0%) were classified in the high surgical difficulty group, while 141 (87.0%) were in the low surgical difficulty group. Multivariate logistic regression analysis showed that the surgical approach using laparoscopic intersphincteric dissection, intraoperative preventive ostomy, and the sacrococcygeal distance were independent risk factors for highly difficult laparoscopic radical sphincter-sparing surgery for rectal cancer (P < 0.05). Conversely, the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance was identified as a protective factor (P < 0.05). A nomogram was subsequently constructed, demonstrating good predictive accuracy (C-index = 0.834). CONCLUSION The surgical approach, intraoperative preventive ostomy, the sacrococcygeal distance, and the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance could help to predict the difficulty of laparoscopic radical sphincter-preserving surgery.
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Affiliation(s)
- Xiao-Cong Zhou
- Department of Colorectal Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
| | - Shi-Wei Guan
- Department of Hepatobiliary Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
| | - Fei-Yue Ke
- Postgraduate Training Base Alliance of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Gaurav Dhamija
- School of International Studies, Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Qiang Wang
- Department of Radiology, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
| | - Bang-Fei Chen
- Department of Colorectal Surgery, The Affiliated Zhejiang Hospital, Zhejiang University School of Medicine (Zhejiang Hospital), Hangzhou 310000, Zhejiang Province, China
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Maeda C, Yamaoka Y, Shiomi A, Kagawa H, Hino H, Manabe S, Kai C, Nanishi K. Short-term and long-term outcomes after robotic radical surgery for rectal gastrointestinal stromal tumor. BMC Surg 2024; 24:141. [PMID: 38720315 PMCID: PMC11080177 DOI: 10.1186/s12893-024-02434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The optimal approach for ensuring both complete resection and preservation of anal function in rectal gastrointestinal stromal tumor (GIST) remains unknown. The aim of this study was to clarify short-term and long-term outcomes after robotic radical surgery for rectal GIST. METHODS A total of 13 patients who underwent robotic radical surgery for rectal GIST between December 2011 and April 2022 were included. All robotic procedures were performed using a systematic approach. A supplemental video of robotic radical surgery for rectal GIST is attached. The short-term outcome was the incidence of postoperative complications during the first 30 days after surgery. Surgical outcomes were retrieved from a prospective database. Long-term outcomes, including overall survival and recurrence-free survival, were determined in all patients. RESULTS Median distance from the tumor to the anal verge was 4.0 cm. Surgical margins were negative in all patients. Two patients underwent neoadjuvant imatinib therapy. All patients underwent sphincter-preserving surgery. None underwent conversion to open or laparoscopic surgery. The incidence of postoperative Clavien-Dindo grade II and grade ≥ III complications was 7.7% and 0%, respectively. The median postoperative hospital stay was 7 days. Twelve patients (92.3%) underwent stoma closure within 5 months of the initial surgery. Median follow-up time was 76 months. The 5-year overall survival and recurrence-free survival rates were both 100%. None of the patients had recurrence. CONCLUSION Short-term and long-term outcomes after radical robotic surgery for rectal GIST were favorable. Robotic surgery might be a useful surgical approach for rectal GIST.
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Affiliation(s)
- Chikara Maeda
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan.
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Chen Kai
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Kenji Nanishi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
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Guo F, Xia C, Wang Z, Wang R, Gao J, Meng Y, Pan J, Zhang Q, Ren S. Nomogram for predicting the surgical difficulty of laparoscopic total mesorectal excision and exploring the technical advantages of robotic surgery. Front Oncol 2024; 14:1303686. [PMID: 38347843 PMCID: PMC10860337 DOI: 10.3389/fonc.2024.1303686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
Background Total mesorectal excision (TME), represents a key technique in radical surgery for rectal cancer. This study aimed to construct a preoperative nomogram for predicting the surgical difficulty of laparoscopic total mesorectal excision (L-TME) and to investigate whether there were potential benefits of robotic TME (R-TME) for patients with technically challenging rectal cancer. Methods Consecutive mid-low rectal cancer patients receiving total mesorectal excision were included. A preoperative nomogram to predict the surgical difficulty of L-TME was established and validated. Patients with technically challenging rectal cancer were screened by calculating the prediction score of the nomogram. Then patients with technically challenging rectal cancer who underwent different types of surgery, R-TME or L-TME, were analyzed for comparison. Results A total of 533 consecutive patients with mid-low rectal cancer who underwent TME at a single tertiary medical center between January 2018 and January 2021 were retrospectively enrolled. Multivariable analysis demonstrated that mesorectal fat area, intertuberous distance, tumor size, and tumor height were independent risk factors for surgical difficulty. Subsequently, these variables were used to construct the nomogram model to predict the surgical difficulty of L-TME. The area under the receiver operating characteristic curve of the nomogram was 0.827 (95% CI 0.745 - 0.909) and 0.809 (95% CI 0.674- 0.944) in the training and validation cohort, respectively. For patients with technically challenging rectal cancer, R-TME was associated with a lower diverting ileostomy rate (p = 0.003), less estimated blood loss (p < 0.043), shorter procedure time (p = 0.009) and shorter postoperative hospital stay (p = 0.037). Conclusion In this study, we established a preoperative nomogram to predict the surgical difficulty of L-TME. Furthermore, this study also indicated that R-TME has potential technical advantages for patients with technically challenging rectal cancer.
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Affiliation(s)
- Fangliang Guo
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Cong Xia
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zongheng Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ruiqi Wang
- Department of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Jianfeng Gao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yue Meng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jiahao Pan
- Department of General Surgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Qianshi Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shuangyi Ren
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Sekkat H, Souadka A, Courtot L, Rafik A, Amrani L, Benkabbou A, Peyrafort P, Giger-Pabst U, Karam E, Mohsine R, Majbar AM, Ouaissi M. Available prediction scores of conversion for laparoscopic rectal cancer surgery seem to be unsuitable for nowadays rectal cancer management. BMC Surg 2022; 22:162. [PMID: 35538528 PMCID: PMC9092680 DOI: 10.1186/s12893-022-01617-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction This study aimed to externally evaluate the accuracy of four predictive scores for conversion to open surgery after rectal laparoscopic resection. None of the four scores achieved external validation previously. Methods This was a retrospective analysis of two prospectively maintained databases from two academic centers in France and Morocco. All consecutive patients who underwent laparoscopic resection for rectal adenocarcinoma between 2005 and 2020 were included. Logistic regression was used to assess the association between the factors present in the four scores and conversion. The accuracy of each score was assessed using the area under the curve (AUC). Observed and predicted conversion rates were compared for each score using the Chi-square goodness-of-fit test. Results Four hundred patients were included. There were 264 men (66%) with a mean age of 65.95 years (standard deviation 12.2). The median tumor height was 7 cm (quartiles 4–11) and 29% of patients had low rectal tumors. Conversion rate was 21.75%. The accuracy to predict conversion was low with an AUC lower than 0,62 for the four models. The observed conversion rates were significantly different from the predicted rates, except for one score. Conclusions The four models had low accuracy in predicting the conversion to open surgery for laparoscopic rectal resection. There is a need for new well-designed studies, analyzing more specific variables, in a multicentric design to ensure generalizability of the results for daily surgical practice.
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Affiliation(s)
- Hamza Sekkat
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Souadka
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Lise Courtot
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Ali Rafik
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Laila Amrani
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Pierre Peyrafort
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Urs Giger-Pabst
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France.,EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
| | - Elias Karam
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Raouf Mohsine
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Anass M Majbar
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco. .,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco.
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France.,EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
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Yamamoto T, Kawada K, Kiyasu Y, Itatani Y, Mizuno R, Hida K, Sakai Y. Prediction of surgical difficulty in minimally invasive surgery for rectal cancer by use of MRI pelvimetry. BJS Open 2020; 4:666-677. [PMID: 32342670 PMCID: PMC7397373 DOI: 10.1002/bjs5.50292] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/23/2020] [Indexed: 01/17/2023] Open
Abstract
Background Technical difficulties in rectal surgery are often related to dissection in a limited surgical field. This study investigated the clinical value of MRI pelvimetry in the prediction of surgical difficulty associated with minimally invasive rectal surgery. Methods Patients with rectal cancer who underwent laparoscopic or robotic total mesorectal excision between 2005 and 2017 were reviewed retrospectively and categorized according to surgical difficulty on the basis of duration of surgery, conversion to an open procedure, use of the transanal approach, postoperative hospital stay, blood loss and postoperative complications. Preoperative clinical and MRI‐related parameters were examined to develop a prediction model to estimate the extent of surgical difficulty, and to compare anastomotic leakage rates in the low‐ and high‐grade surgical difficulty groups. Prognosis was investigated by calculating overall and relapse‐free survival, and cumulative local and distant recurrence rates. Results Of 121 patients analysed, 104 (86·0 per cent) were categorized into the low‐grade group and 17 (14·0 per cent) into the high‐grade group. Multivariable analysis indicated that high‐grade surgical difficulty was associated with a BMI above 25 kg/m2 (odds ratio (OR) 4·45, P = 0·033), tumour size 45 mm or more (OR 5·42, P = 0·042), anorectal angle 123° or more (OR 5·98, P = 0·028) and pelvic outlet less than 82·7 mm (OR 6·62, P = 0·048). All of these features were used to devise a four‐variable scoring model to predict surgical difficulty. In patients categorized as high grade for surgical difficulty, the anastomotic leakage rate was 53 per cent (9 of 17 patients), compared with 9·6 per cent (10 of 104) in the low‐grade group (P < 0·001). The high‐grade group had a significantly higher local recurrence rate than the low‐grade group (P = 0·002). Conclusion This study highlights the impact of clinical variables and MRI pelvimetry in the prediction of surgical difficulty in minimally invasive rectal surgery.
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Affiliation(s)
- T Yamamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, Japan, 606-8507
| | - K Kawada
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, Japan, 606-8507
| | - Y Kiyasu
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, Japan, 606-8507
| | - Y Itatani
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, Japan, 606-8507
| | - R Mizuno
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, Japan, 606-8507
| | - K Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, Japan, 606-8507
| | - Y Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, Japan, 606-8507
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Magnetic resonance-based pelvimetry and tumor volumetry can predict surgical difficulty and oncologic outcome in locally advanced mid-low rectal cancer. Surg Today 2018; 48:1040-1051. [PMID: 29961173 DOI: 10.1007/s00595-018-1690-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/24/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the impact of the pelvic dimensions and tumor volume on surgery in locally advanced rectal cancer. METHODS Patients who underwent open surgery after neoadjuvant long-course chemoradiation for primary rectal cancer were included. The predictive value of magnetic resonance-based pelvic measurements and tumor volume on the surgical difficulty and oncologic outcome were analyzed. RESULTS 125 patients were included. The independent risk factors related to the circumferential resection margin status were the pT stage [odds ratio (OR) 3.64, confidence interval (CI) 1.409-7.327] and tumor volume after neoadjuvant chemoradiotherapy (OR 1.59, CI 1.018-2.767). The operative time (p = 0.014, OR 1.453) and pelvic depth (p = 0.023, OR 1.116) were independent predictive factors for anastomotic leak. The median follow-up was 72 (2-113) months. Local recurrence was seen in 17 (14.1%) patients. Anastomotic leak (OR 1.799, CI 0.978-3.277), the circumferential resection margin status (OR 3.217, CI 1.262-7.870) and the relative tumor volume rate (OR 1.260, CI 1.004-1.912) were independent prognosticators of local recurrence. The 5-year overall survival was 66.7%. The circumferential resection margin status (hazard ratio: 4.739, CI 2.276-9.317), pN stage (OR 3.267, CI 1.195-8.930) and relative tumor volume rate (OR 2.628, CI 1.042-6.631) were independent prognostic factors for the overall survival. CONCLUSIONS Relative dimensions of the tumor in the pelvis influence the local recurrence and overall survival rates. Magnetic resonance-based measurements can predict the difficulty of surgery and allow surgeons to consider the appropriate surgical approach.
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Increased perirenal fat area is not associated with adverse outcomes after laparoscopic total mesorectal excision for rectal cancer. Langenbecks Arch Surg 2017; 402:1205-1211. [DOI: 10.1007/s00423-017-1636-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/01/2017] [Indexed: 12/27/2022]
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Prediction of Anastomotic Leakage After Laparoscopic Low Anterior Resection in Male Rectal Cancer by Pelvic Measurement in Magnetic Resonance Imaging. Surg Laparosc Endosc Percutan Tech 2017; 27:54-59. [PMID: 28092330 PMCID: PMC5287437 DOI: 10.1097/sle.0000000000000366] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Anastomotic leakage after laparoscopic low anterior resection in male rectal cancer patients with a narrow pelvis cannot be easily resolved. The objective of this study is to assess numerical information of narrow pelvis and to determine whether prediction of morbidity can be possible. METHODS Retrospective medical record review was performed. From July 2007 to January 2013, 43 consecutive male patients with low rectal cancer who underwent laparoscopic low anterior resection were divided into the anastomotic leakage-negative group and anastomotic leakage-positive group. Eleven anatomic parameters were measured from preoperative magnetic resonance imaging of pelvis and a new index called "pelvic index" was calculated. RESULTS The pelvic index (difference between the interspinous distance and the diameter of the mesorectum divided by the depth of the cavity of the lesser pelvis) in the leakage-positive group was significantly smaller than that in the negative group (P=0.038). Comparison between those 2 groups at the border of the cut-off value of the pelvic index (13.0) showed a significant difference. CONCLUSIONS Preoperative assessment by the pelvic index can predict the narrow pelvis and risk of anastomotic leakage.
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Bhama AR, Wafa AM, Ferraro J, Collins SD, Mullard AJ, Vandewarker JF, Krapohl G, Byrn JC, Cleary RK. Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database. J Gastrointest Surg 2016; 20:1223-30. [PMID: 26847352 DOI: 10.1007/s11605-016-3090-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/21/2016] [Indexed: 01/31/2023]
Abstract
Robotic colorectal surgery has been shown to have lower rates of unplanned conversion to open surgery when compared to laparoscopic surgery. Risk factors associated with conversion from robotic to open colectomy and comparisons of the risk factors between robotic and laparoscopic approaches have not been previously reported. Patients who underwent elective laparoscopic and robotic colorectal surgeries between July 1, 2012 and April 28, 2015, were identified in the Michigan Surgical Quality Collaborative registry. Candidate covariates were identified, and hierarchical logistic regression models were used to identify risk factors for conversion. There were 4796 cases that met study inclusion criteria. Conversion was required in 18.2 % of laparoscopic and 7.7 % of robotic cases (p < 0.0001). Risk factors for conversion in the laparoscopic group included the following: moderate/severe adhesions, obesity, colorectal cancer, hypertension, rectal operations, urgent priority, and tobacco use. Risk factors for conversion in the robotic group included the following: severe adhesions, bleeding disorder, presence of cancer, cirrhosis, and use of statins. Higher surgeon volume was protective in both groups. Conversion rates are lower for robotic than for laparoscopic colorectal surgery with fewer predictors of conversion. Recognition of factors predicting conversion may allow surgeons to choose an operative approach that optimizes the benefits of the available technologies.
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Affiliation(s)
- Anuradha R Bhama
- Department of Surgery, Division of Colon and Rectal Surgery, St. Joseph Mercy Health System-Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA.
| | - Abdullah M Wafa
- Department of Surgery, Division of Colon and Rectal Surgery, St. Joseph Mercy Health System-Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA
| | - Jane Ferraro
- Department of Surgery, Division of Colon and Rectal Surgery, St. Joseph Mercy Health System-Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA
| | - Stacey D Collins
- Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI, 48104, USA
| | - Andrew J Mullard
- Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI, 48104, USA
| | - James F Vandewarker
- Department of Surgery, Division of Colon and Rectal Surgery, St. Joseph Mercy Health System-Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA
| | - Greta Krapohl
- Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI, 48104, USA
| | - John C Byrn
- Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI, 48104, USA
| | - Robert K Cleary
- Department of Surgery, Division of Colon and Rectal Surgery, St. Joseph Mercy Health System-Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA
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Gezen FC, Aytac E, Costedio MM, Vogel JD, Gorgun E. Hand-Assisted versus Straight-Laparoscopic versus Open Proctosigmoidectomy for Treatment of Sigmoid and Rectal Cancer: A Case-Matched Study of 100 Patients. Perm J 2016; 19:10-4. [PMID: 25902342 DOI: 10.7812/tpp/14-102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To assess the efficacy of laparoscopic proctosigmoidectomy for cancer treatment, 25 patients who underwent hand-assisted laparoscopic resection during the study period (9/2006 - 7/2012) were matched to 25 straight-laparoscopic and 50 open-surgery cases. The patients who underwent hand-assisted resection had higher rates of preoperative cardiac disease and hypertension than did the straight-laparoscopy and open-surgery groups. Straight-laparoscopic surgery seems to provide faster convalescence compared with open surgery and hand-assisted laparoscopic surgery.
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Affiliation(s)
- Fazli C Gezen
- Research Fellow in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
| | - Erman Aytac
- Clinical Research Fellow in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
| | - Meagan M Costedio
- Colorectal Surgeon in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
| | - Jon D Vogel
- Associate Professor of Surgery in the Department of Surgery at the University of Colorado School of Medicine in Denver. He was formerly a Colorectal Surgeon in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
| | - Emre Gorgun
- Colorectal Surgeon in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
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12
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13
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Zhang GD, Zhi XT, Zhang JL, Bu GB, Ma G, Wang KL. Preoperative prediction of conversion from laparoscopic rectal resection to open surgery: a clinical study of conversion scoring of laparoscopic rectal resection to open surgery. Int J Colorectal Dis 2015; 30:1209-16. [PMID: 26077668 DOI: 10.1007/s00384-015-2275-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objectives of this paper were to establish a model for the conversion of laparoscopic rectal resection to open surgery and to predict possible conversion before surgery. METHODS The clinical data of 602 cases of laparoscopic rectal resection were retrospectively assessed. Risk factors associated with conversion of laparoscopic rectal resection to open rectal surgery were identified by logistic regression analysis. Also, a scoring system was created to calculate a score for the conversion of laparoscopic rectal resection to predict possible conversion for patients who underwent laparoscopic rectal resection before surgery. RESULTS A total of 90 patients required conversion (total conversion rate = 14.95%). The established model included six variables: male gender, surgical experience (≤25 cases), history of abdominal surgery, body mass index ≥ 28, tumor diameter ≥ 6 cm, and tumor invasion or metastasis, for which 6, 4, 5, 10, 15, and 21 points were assigned, respectively. A patient with a total score >14.5 points was considered to have a high probability of conversion, whereas a patient with a total score <14.5 points was considered at a low risk. CONCLUSION Preoperative determination of conversion score may predict possible conversion of laparoscopic rectal resection and thus reduce unnecessary open rectal surgery.
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Affiliation(s)
- Guang-Dong Zhang
- Department of General Surgery, Qi Lu Hospital of Shandong University, 107#, Wenhua Xi Road, Jinan City, 250012, China,
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Kleemann M, Benecke C, Helfrich D, Bruch HP, Keck T, Laubert T. Prospective Analysis of More than 1,000 Patients with Rectal Carcinoma: Are There Gender-Related Differences? VISZERALMEDIZIN 2015; 30:118-24. [PMID: 26288586 PMCID: PMC4513819 DOI: 10.1159/000362680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Since the beginning of the new millennium gender medicine has become more and more relevant. The goal has been to unveil differences in presentation, treatment response, and prognosis of men and women with regard to various diseases. Methods This study encompassed 1,061 patients who underwent surgery for rectal cancer at the Department of Surgery, University Medical Center Schleswig-Holstein Campus Lübeck, Germany, between January 1990 and December 2011. Prospectively documented demographic, clinical, pathological, and follow-up data were obtained. Analysis encompassed the comparison of clinical, histopathological, and oncological parameters with regard to the subcohorts of male and female patients. Results No statistically significant differences could be found for clinical and histopathological parameters, location of tumor, resection with or without anastomosis, palliative or curative treatment, conversion rates, duration of surgery, and long-term survival. For the entire cohort, gender-related statistically significant differences in complications encompassed anastomotic leakage, burst abdomen, pneumonia, and urinary tract complications all of which occurred more often in men. Conclusion Data obtained in this study suggest that there are no gender-related differences in the oncologic surgical treatment of patients with rectal carcinoma. However, male sex seems to be a risk factor for increased early postoperative morbidity.
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Affiliation(s)
- Markus Kleemann
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Berlin, Germany
| | - Claudia Benecke
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Berlin, Germany
| | - Diana Helfrich
- Lübeck Medical School, University of Lübeck, Berlin, Germany
| | - Hans-Peter Bruch
- Berufsverband der Deutschen Chirurgen e.V. (BDC), Berlin, Germany
| | - Tobias Keck
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Berlin, Germany
| | - Tilman Laubert
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Berlin, Germany
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15
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Baek SJ, Kim CH, Cho MS, Bae SU, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Robotic surgery for rectal cancer can overcome difficulties associated with pelvic anatomy. Surg Endosc 2015; 29:1419-1424. [PMID: 25159651 DOI: 10.1007/s00464-014-3818-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 08/08/2014] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Total mesorectal excision (TME) for rectal cancer can be challenging to perform in the presence of difficult pelvic anatomy. In our previous studies based on open and laparoscopic TME, we found that pelvic MRI-based pelvimetry could well reflect anatomical difficulty of the pelvis and operative time increased in direct proportion to the difficulty. We explored different outcomes of robotic surgery for TME based on classifications of difficult pelvic anatomies to determine whether this method can overcome these challenges. METHODS We reviewed data from 182 patients who underwent robotic surgery for rectal cancer between January 2008 and August 2010. Patient demographics, pathologic outcomes, pelvimetric results, and operative and postoperative outcomes were assessed. The data were compared between easy, moderate, and difficult groups classified by MRI-based pelvimetry. RESULTS Comparing the three groups, there was no difference between the groups in terms of operative and pathologic outcomes, including operation time. High BMI, history of preoperative chemoradiotherapy, and lower tumor levels were significantly associated with longer operation time (p < 0.001, p < 0.001, p = 0.009), but the pelvimetric parameter was not. CONCLUSION There was no difference between the easy, moderate, and difficult groups in terms of surgical outcomes, such as operation time, for robotic rectal surgery. The robot system can provide more comfort during surgery for the surgeon, and may overcome challenges associated with difficult pelvic anatomy.
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Affiliation(s)
- Se Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-527, South Korea,
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16
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Risk prediction score in laparoscopic colorectal surgery training: experience from the English National Training Program. Ann Surg 2015; 261:338-44. [PMID: 24646565 DOI: 10.1097/sla.0000000000000651] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The overall aim was to develop and validate a risk prediction score for laparoscopic colorectal surgery training cases. BACKGROUND Published risk prediction scores are not transferable between hospitals because they are derived from a single institution's data and are not designed for use in training situations. METHODS Cases from the prospectively collected database of the National Training Programme in Laparoscopic Colorectal Surgery, between July 2008 and July 2012, were analyzed. Independent risk factors for conversion were identified by the logistic regression. Converting the odds ratios into integers created a risk prediction score for conversion. The clinical impact of this score was investigated by comparing postoperative complications and the level of trainer input in high- and low-risk cases. To study whether adverse outcomes in predicted high-risk cases occur outside the National Training Programme in Laparoscopic Colorectal Surgery, 2 external data sets were examined. RESULTS A total of 2341 cases carried out in 42 hospitals were analyzed. Significant risk factors for conversion were body mass index, American Society of Anesthesiology classification, male sex, prior abdominal surgery, and resection type. At a risk score of more than 6, complication rates increased, including mortality (2.9% vs 0.5%, P < 0.001), anastomotic leak (4.3% vs 1.4%, P = 0.002), and a higher level of trainer input (32.2% vs 19.9% of cases, P < 0.001). Analysis of 786 external cases showed that high-risk cases had higher conversion (18.8% vs 7.1%, P < 0.001), overall complication (36.4% vs 15.0%, P < 0.001), and leak rates (4.0% vs 1.3%, P = 0.015). CONCLUSIONS A risk predication score to facilitate case selection in laparoscopic colorectal surgery training was developed and validated.
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Fernández Ananín S, Targarona EM, Martinez C, Pernas JC, Hernández D, Gich I, Sancho FJ, Trias M. Predicting the pathological features of the mesorectum before the laparoscopic approach to rectal cancer. Surg Endosc 2014; 28:3458-66. [PMID: 24950725 DOI: 10.1007/s00464-014-3622-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/06/2014] [Indexed: 12/18/2022]
Abstract
Pelvic anatomy and tumour features play a role in the difficulty of the laparoscopic approach to total mesorectal excision in rectal cancer. The aim of the study was to analyse whether these characteristics also influence the quality of the surgical specimen. We performed a prospective study in consecutive patients with rectal cancer located less than 12 cm from the anal verge who underwent laparoscopic surgery between January 2010 and July 2013. Exclusion criteria were T1 and T4 tumours, abdominoperineal resections, obstructive and perforated tumours, or any major contraindication for laparoscopic surgery. Dependent variables were the circumferential resection margin (CMR) and the quality of the mesorectum. Sixty-four patients underwent laparoscopic sphincter-preserving total mesorectal excision. Resection was complete in 79.1% of specimens and CMR was positive in 9.7%. Univariate analysis showed tumour depth (T status) (P = 0.04) and promontorium-subsacrum angle (P = 0.02) independently predicted CRM (circumferential resection margin) positivity. Tumour depth (P < 0.05) and promontorium-subsacrum axis (P < 0.05) independently predicted mesorectum quality. Multivariate analysis identified the promontorium-subsacrum angle (P = 0.012) as the only independent predictor of CRM. Bony pelvis dimensions influenced the quality of the specimen obtained by laparoscopy. These measurements may be useful to predict which patients will benefit most from laparoscopic surgery and also to select patients in accordance with the learning curve of trainee surgeons.
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Affiliation(s)
- Sonia Fernández Ananín
- Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Sant Quintí, 89, 08026, Barcelona, Spain,
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Wang C, Xiao Y, Qiu H, Yao J, Pan W. Factors affecting operating time in laparoscopic anterior resection of rectal cancer. World J Surg Oncol 2014; 12:44. [PMID: 24568575 PMCID: PMC3941695 DOI: 10.1186/1477-7819-12-44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/10/2014] [Indexed: 02/07/2023] Open
Abstract
Background The objective of this study is to clarify the relationship between demographic and surgical factors and operating time, and thus operative difficulty, in patients undergoing laparoscopic anterior resection for mid-low rectal cancer, since different studies have derived different results. Methods The records of patients with mid-low rectal cancer who underwent laparoscopic anterior resection were retrospectively studied. Demographic data, tumor characteristics, and pelvimetry measurements were collected and analyzed with respect to operating time, using correlation coefficient analysis, principle component analysis, and linear regression. Results A total of 14 patients (10 males, 4 females; 65.50 ± 7.12 years of age) were included. Demographic and tumor characteristics not correlated with operating time. Body mass index (BMI) (P = 0.001); interacetabular distance (IA) (P = 0.001); anatomical transverse distance (IP) (P = 0.008); interischial distance (IS) (P = 0.002); intertuberous distance (IT) (P = 0.005); distance between the coccyx and symphysis (CoSy) (P = 0.013); and the angle of the lower border of the symphysis pubis, upper border of symphysis pubis, and sacral promontory (angle 5) (P = 0.004) were significantly associated with operating time. The equation was: operatingtime=0.653×BMI+0.818×angle5-0.404×IA-0.380×IP-0.512×IS-0.405×IT-0.570×CoSy+330.8. Conclusions Transverse diameters of the pelvis, BMI, angle 5, and CoSy played the most important role in affecting operating time. The equation can be a very useful tool for preoperative assessment.
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Affiliation(s)
| | - Yi Xiao
- Department of General Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Shuaifuyuan 1, Dongcheng District, Beijing 100730, China.
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Abstract
INTRODUCTION Minimally invasive surgery has many potential benefits, and the application of recently developed robotic technology to patients with colorectal diseases is rapidly gaining popularity. QUALITY AND OUTCOMES However, the literature evaluating such techniques, including the outcomes, risks, and costs, is limited. In this review, we evaluate and summarize the existing information, calling attention to areas where future investigation should occur.
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Affiliation(s)
- Carrie Y Peterson
- Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-1075, New York, NY, 10065, USA
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Gong J, Shi DB, Li XX, Cai SJ, Guan ZQ, Xu Y. Short-term outcomes of laparoscopic total mesorectal excision compared to open surgery. World J Gastroenterol 2012; 18:7308-7313. [PMID: 23326138 PMCID: PMC3544035 DOI: 10.3748/wjg.v18.i48.7308] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/25/2012] [Accepted: 11/15/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the short-term outcome of laparoscopic total mesorectal excision (TME) in patients with mid and low rectal cancers.
METHODS: A consecutive series of 138 patients with middle and low rectal cancer were randomly assigned to either the laparoscopic TME (LTME) group or the open TME (OTME) group between September 2008 and July 2011 at the Department of Colorectal Cancer of Shanghai Cancer Center, Fudan University and pathological data, as well as surgical technique were reviewed retrospectively. Short-term clinical and oncological outcome were compared in these two groups. Patients were followed in the outpatient clinic 2 wk after the surgery and then every 3 mo in the first year if no adjuvant chemoradiation was indicated. Statistical analysis was performed using SPSS 13.0 software.
RESULTS: Sixty-seven patients were treated with LTME and 71 patients were treated with OTME (sex ratio 1.3:1 vs 1.29:1, age 58.4 ± 13.6 years vs 59.6 ± 9.4 years, respectively). The resection was considered curative in all cases. The sphincter-preserving rate was 65.7% (44/67) vs 60.6% (43/71), P = 0.046; mean blood loss was 86.9 ± 37.6 mL vs 119.1 ± 32.7 mL, P = 0.018; postoperative analgesia was 2.1 ± 0.6 d vs 3.9 ± 1.8 d, P = 0.008; duration of urinary drainage was 4.7 ± 1.8 d vs 6.9 ± 3.4 d, P = 0.016, respectively. The conversion rate was 2.99%. The complication rate, circumferential margin involvement, distal margins and lymph node yield were similar for both procedures. No port site recurrence, anastomotic recurrence or mortality was observed during a median follow-up period of 21 mo (range: 9-56 mo).
CONCLUSION: Laparoscopic TME is safe and feasible, with an oncological adequacy comparable to the open approach. Further studies with more patients and longer follow-up are needed to confirm the present results.
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