Factors Affecting the Difficulty of Laparoscopic Total Mesorectal Excision for Rectal Cancer

Cho Tae-ho, MD, Baek Jeong-heum, MD, Lee Won-suk, MD, Lee Woon-kee, MD, Kang Jeong-hyun, MD. Department of Surgery, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea


Keyword : Total mesorectal excision(TME), Pelvic dissection time, Rectal cancer, Degree of difficulty

INTRODUCTION – The laparoscopic approach for rectal cancer is being performed with increasing frequency worldwide. But its definitive role is controversial due to the technical difficulty. The aim of this study was to evaluate the predictive value of anatomic and clinical features affecting the difficulty of laparoscopic total mesorectal excision (TME).

METHODS AND PROCEDURES – A total of 55 patients who underwent laparoscopic TME for rectal cancer from January 2011 to August 2011 were evaluated. Gender, body mass index (BMI), tumor depth, tumor size, tumor distance from anal verge, preoperative chemoradiotherapy, and 5 pelvic dimensions (pelvic inlet, pelvic outlet, length of sacrum, interspinous distance, intertuborous distance) in pelvic MRI were analysed as potential variables affecting the difficulties of laparoscopic TME. The dependent variable is pelvic dissection time, which was defined as the time required for dissection of rectum from the pelvis. Immediate perioperative outcome (estimated blood loss (EBL), morbidity, hospital stay) were also collected.

RESULTS – The series included 41 men and 14 women, with a mean age of 65 years (range, 51-90), Mean pelvic dissection time 45 minute, EBL 87mL morbidity 18.2%, mean hospital stay 10.36 days. Gender, tumor distance from the anal verge, preoperative chemoradiotherapy, interspinous distance, intertuberous distance had significant correlation to pelvic dissection time.

CONCLUSION – Male gender, preoperative chemoradiation, close tumor distance to anal verge, and narrow pelvic cavity seemed factors affecting the difficulty of laparoscopic TME. These factors should be taken into account when planning laparoscopic TME.

Session Number: Poster – Poster Presentations
Program Number: P065
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