F Borja DeLacy, MD1, Jacqueline van Laarhoven, MD2, Romina Pena, MD1, María Clara Arroyave3, María Fernández-Hevia, MD1, Dulce Momblán1, Antonio M. Lacy1. 1Hospital Clinic of Barcelona, 2Jeroen Bosch Ziekenhuis, 3Clínica Somer
Introduction: Laparoscopic rectal cancer surgery is a technically demanding procedure, especially in patients with adverse circumstances such as obesity. High BMI has been associated with increased morbidity. Transanal total mesorectal excision (taTME) has emerged as an alternative to open and laparoscopic techniques and might be associated with improved outcomes in such difficult cases.
Methods and procedures: From a prospectively maintained database of patients undergoing taTME for rectal cancer in a tertiary referral center, we analyzed the outcomes of patients with BMI<25 Kg/m2 (non-obese group) and patients with BMI>30 Kg/m2 (obese group). Both groups were compared on patient characteristics, intraoperative and postoperative complications. Patients with mid and low rectal cancer were included.
Results: A total of 104 patients were included in the analysis, 83 patients (79.8%) had a BMI of <25 Kg/m2 and 21 patients (20.2%) had a BMI>30 Kg/m2. Both groups did not differ in male-female ratio (male patients: 53.0% vs. 66.7%, p=0.260) or median age (63 vs. 66 years). Also there was no difference in incidence of nicotine use (31.4% vs. 30.0%, p=903). There was an expected increased risk in the ASA classification for the obese group. T3 disease was present in 62 (77.5%) vs. 13 (61.9%) patients (p=0.146), and T4 was present in 7 (8.8%) vs. 1 (4.8%) patient (p=0.547), with no difference in the administration of neoadjuvancy (71.0% vs. 61.9%; p=0.575). Median operative time was 120 vs. 160 min (p=0.051). Intraoperative complications were present in 5 (6.4%) vs. 3 (15.0%) (p=0.211), being hemorrhage (n=4 vs. n=0) the most frequent. There was 1 case of perforation of the posterior vaginal wall in the obese group. No ureter injuries were documented, and abdominal conversion to hand-port occurred in 1 (1.2%) vs. none (p=0.613). The 30-days postoperative complication rate was 30 (36.6%) vs. 9 (42.9%) (p=0.597). A reintervention was warranted in 6 (7.3%) vs. 1 (4.8%) case (p=0.678), while readmission rate was 9.9% vs. 9.5% (p=0.961). Median length of hospital stay was 6 vs. 7 days (p=0.280). Pathological results showed no difference concerning quality of the specimen between both groups (98.8% vs. 100.0% of completeness of mesorectum, p=0.611) and no difference in positive CRM (8.5% vs. 4.8%, p=564).
Conclusion: Despite increased technical difficulty of resection, with taTME obesity seems to be no longer associated with higher morbidity.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80215
Program Number: P254
Presentation Session: Poster (Non CME)
Presentation Type: Poster
