Kayleigh Risser, RA, Reza Gamagami, MD. Silver Cross Hospital
Background: With increasing adoption of laparoscopy for the treatment of colorectal neoplasms, accurate preoperative localization is crucial as most tumors are invisible intraoperatively. There is usually no tactile feedback to assess the presence of a neoplasm. Furthermore, for rectal and rectosigmoid neoplasms, an accurate distance from anal verge will impact whether a patient will receive a colorectal anastomosis versus a coloanal anastomosis with a diversion. The aim of this study was to determine if there was a significant difference between the location of the left-sided colonic neoplasm described by the gastroenterologist as compared to the one performed by the operating surgeon prior to surgery.
Patients and Methods: A single surgeon retrospective analysis of patients referred for left-sided colonic neoplasm (n=85) for laparoscopic surgery from May 2012 to August 2018 was evaluated. Assessed data included: rectal vs. colonic, presence or absence of endoscopic tattoo and/or clip, and description of anatomical location and distance from the anal verge. Findings were compared to the operating surgeon’s preoperative endoscopic evaluation.
Results: We identified 85 patients, 7 with colonic and 68 patients with rectal and rectosigmoid neoplasms. The absolute difference between the gastroenterologist and the surgeon for anatomic location for rectal/rectosigmoid and colonic neoplasms was 24% and 45% respectively. For patients with rectal neoplasm, 16% of patients had no data for distance from anal verge by the gastroenterologist. The discrepancy between the gastroenterologist and the surgeon for distance from anal verge for rectal/rectosigmoid neoplasms was subcategorized to 2 to <5 cm, 5-10 cm and >10 cm, with observed difference of 33%, 15% and 4% respectively.
Conclusion: There is a significant difference between the location of left-sided colorectal neoplasm reported by the gastroenterologist and that determined by the surgeon preoperatively. Patients undergoing left-sided colonic resection should undergo endoscopic evaluation by the operating surgeon before elective resection. Efforts should be made to improve endoscopic localization by gastroenterologist to accurately guide surgical resection.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95066
Program Number: P308
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster