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Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer
Surgery, 07/15/09

Akiyoshi T et al. - In a study to evaluate the influence of pt and tumor factors, particularly pelvic dimensions, on difficulties in laparoscopic total mesorectal excision (TME) for low rectal cancer, it appears that body mass index (BMI), tumor distance from the anal verge, tumor depth, and pelvic outlet were independent predictors for operative time and morbidity. These factors should be taken into account when planning laparoscopic TME.

• 79 consecutive pts underwent laparoscopic TME with intracorporeal rectal transection and double stapling technique (DST) anastomosis for low rectal cancer.
• Gender, BMI, tumor diameter, tumor depth, tumor distance from the anal verge, preoperative chemoradiotherapy, 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.
• Dependent variables were pelvic operative time, intracorporeal transaction, and anastomosis.
• Other dependent variables were intraoperative blood loss, overall postoperative morbidity, and anastomotic leakage.
• Univariate and multivariate analyses were performed to determine the predictive significance of variables.

• Multivariate analysis showed that BMI, tumor distance from the anal verge, tumor depth, and pelvic outlet were independently predictive of pelvic operative time.
• Pelvic operative time was related to intraoperative blood loss.
• Tumor distance from the anal verge was related to postoperative morbidity, and pelvic outlet was related to anastomotic leakage.

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