Hand-Assisted Laparoscopic Pelvic Nerve Sparing Resection of Rectal Cancer: Preoperative Chemoradiation Influences Conversion Rate

Introduction: We hypothesize that gender, BMI and preoperative chemoradiation may influence the ability to perform a hand-assisted laparoscopic (HAL) resection for patients with rectal cancer.
Methods: We performed retrospective analysis of patients who underwent HAL resection of rectal cancer. Four trocars and a standard 7 cm incision length were used. We abstracted clinical and pathological variables to examine conversion rate, number of lymph nodes harvested, radial margin, length of stay, and local recurrence. We performed descriptive analyses and Fishers Exact probability test (2-tailed).
Results: Our study evaluated 32 patients (12 females, 20 males) with a mean age of 54.8 years and mean BMI of 26. The mean distance of the rectal cancer from the anal verge was 8cm. Preoperative chemoradiation was administered to 59% of the patients who had clinical stage III. 24 patients had a low anterior resection while 8 had abdominoperineal resection. The median length of stay was 7 days. A mean of 15 lymph nodes were harvested and the radial and distal resection margins were tumor free for all patients. Histopathology showed that 71% were T3 lesions and 47% had lymph node metastases. In 9 (34%) patients the operation was converted to open and 25% needed have their incision extended by 2 cm to facilitate pelvic dissection secondary to local tumor bulk. However patients treated with preoperative chemoradiation therapy for clinically stage III rectal cancer were significantly (73% vs 30%, p=0.01) likely to require conversion or extension of incision. Gender and BMI did not influence conversion rate or rate of incision extension.
Conclusions: In our initial experience of HAL rectal resection, we noted that preoperative chemoradiation therapy for clinically stage III increased the conversion rate and the need to extend the incision.

Session: Poster

Program Number: P195

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