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. 2021 Mar;406(2):309-318.
doi: 10.1007/s00423-020-02029-0. Epub 2020 Nov 27.

Risk factors for suboptimal laparoscopic surgery in rectal cancer patients

Pere Planellas  1   2 , Helena Salvador  3 , Lídia Cornejo  4 , Maria Buxó  4 , Ramon Farrés  3   4 , Xavier Molina  5 , Albert Maroto  5 , Núria Ortega  3   4 , Jose Ignacio Rodríguez-Hermosa  3   4 , Antoni Codina-Cazador  3   4
Affiliations

Risk factors for suboptimal laparoscopic surgery in rectal cancer patients

Pere Planellas et al. Langenbecks Arch Surg. 2021 Mar.

Abstract

Purpose: Laparoscopic surgery for rectal cancer is technically complex. This study aimed to identify risk factors for suboptimal laparoscopic surgery (involved margins, incomplete mesorectal excision, and/or conversion to open surgery) in patients with rectal cancer.

Methods: We included patients undergoing laparoscopic anterior resection for rectal cancer between June 2009 and June 2018. We defined the outcome variable suboptimal laparoscopic surgery as conversion to open surgery or inadequate histopathological specimens (margins < 1 mm or involved and/or poor-quality mesorectal excision). To identify independent predictors of suboptimal laparoscopic surgery, we analyzed 15 prospectively recorded demographic, clinical, and anthropometric variables obtained from our rectal cancer unit's database. Subanalyses examined the same variables with respect to conversion and to inadequate histopathological specimens.

Results: Of the 323 patients included, 91 (28.2%) had suboptimal laparoscopic surgery. In the multivariate analysis, the independent factors associated with all suboptimal laparoscopic surgery were tumor location ≤ 5 cm from the anal verge (OR = 2.95, 0.95% CI 1.32-6.60; p = 0.008) and the intertuberous distance (OR = 0.79, 0.95% CI 0.65-0.96; p = 0.019). In the subanalyses, the promontorium-retropubic axis was an independent predictor of conversion (OR 0.70, 0.95% CI 0.51-0.96; p = 0.026), and tumor location ≤ 5 cm from the anal verge (OR 3.71, 0.95% 1.51-9.15; p = 0.004) was an independent predictor of inadequate histopathological specimens.

Conclusions: Predictive factors for suboptimal laparoscopic anterior resection for rectal cancer were tumor location and the intertuberous distance. These results could help surgeons decide whether to use other surgical approaches in complex cases.

Trial registration: The study was registered at Clinicaltrials.org (No. NCT03107650).

Keywords: Colorectal surgery; Laparoscopy; Predictive model; Rectal cancer.

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References

    1. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg 69:613–616 - PubMed
    1. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, Arnold D (2018) Rectal cancer: ESMO clinical practice guidelines. Ann Oncol 28(suppl 4):iv22–iv40
    1. Benson AB, Venook AP, Al-Hawary MM et al (2018) Rectal cancer, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 16:874–901 - PubMed
    1. Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229 - PubMed
    1. Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, Wieand HS et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

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