Factors Influencing Difficulty of Laparoscopic Abdominoperineal Resection for Ultra-Low Rectal Cancer

Li, Qiken; Li, Dechuan; Jiang, Lai; Qiu, Pengnian; Fu, Zhixuan; Tang, Lilong; Chen, Weiping

doi:10.1097/sle.0000000000000378

Cited by 12 publications

(17 citation statements)

References 28 publications

(34 reference statements)

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“…In the literature, other MRI‐based studies identified patient‐ and tumour‐related predictors of surgical difficulty . Most of them found an association between male sex and risk of conversion from laparoscopy to laparotomy , or greater tumour volume with longer operative times .…”

Section: Discussionmentioning

confidence: 99%

Assessing surgical difficulty in locally advanced mid–low rectal cancer: the accuracy of two MRI‐based predictive scores

et al. 2018

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Aim Predicting surgical difficulty is a critical factor in the management of locally advanced rectal cancer (LARC). This study evaluates the accuracy and external validity of a recently published morphometric score to predict surgical difficulty and additionally proposes a new score to identify preoperatively LARC patients with a high risk of having a difficult surgery. Methods This is a retrospective study based on the European MRI and Rectal Cancer Surgery (EuMaRCS) database, including patients with mid/low LARC who were treated with neoadjuvant chemoradiation therapy and laparoscopic total mesorectal excision (L‐TME) with primary anastomosis. For all patients, pretreatment and restaging MRI were available. Surgical difficulty was graded as high and low based upon a composite outcome, including operative (e.g. duration of surgery) and postoperative variables (e.g. hospital stay). Score accuracy was assessed by estimating sensitivity, specificity and area under the receiver operating characteristic curve (AROC). Results In a total of 136 LARC patients, 17 (12.5%) were graded as high surgical difficulty. The previously published score (calculated on body mass index, intertuberous distance, mesorectal fat area, type of anastomosis) showed low predictive value (sensitivity 11.8%; specificity 92.4%; AROC 0.612). The new EuMaRCS score was developed using the following significant predictors of surgical difficulty: body mass index > 30, interspinous distance < 96.4 mm, ymrT stage ≥ T3b and male sex. It demonstrated high accuracy (AROC 0.802). Conclusion The EuMaRCS score was found to be more sensitive and specific than the previous score in predicting surgical difficulty in LARC patients who are candidates for L‐TME. However, this score has yet to be externally validated.

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Section: Discussionmentioning

confidence: 99%

Assessing surgical difficulty in locally advanced mid–low rectal cancer: the accuracy of two MRI‐based predictive scores

et al. 2018

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“…15,18,19 In the current literature, operative time and EBL are often used as surrogate markers for surgical difficulty without directly assessing surgeon-reported difficulty. [4][5][6][7][8][9] We demonstrate that EBL and opera- 20 Previous studies of laparoscopic and robotic surgery have demonstrated that pelvic measurements may impact the difficulty of pelvic surgery due to limited working space. [4][5][6][7]11,21 Using measurements including transverse pelvic diameter as well as the prostate volume:…”

Section: Discussionmentioning

confidence: 64%

“…[4][5][6][7][8][9] We demonstrate that EBL and opera- 20 Previous studies of laparoscopic and robotic surgery have demonstrated that pelvic measurements may impact the difficulty of pelvic surgery due to limited working space. [4][5][6][7]11,21 Using measurements including transverse pelvic diameter as well as the prostate volume:…”

Section: Discussionmentioning

confidence: 64%

“…Previous studies frequently use surrogate measures of surgical complexity such as estimated blood loss (EBL) or operative time, without directly evaluating surgeon feedback on the case complexity. [4][5][6][7][8][9] This study aimed to identify factors that are associated with a surgeon's perception of increased RARP difficulty. We hypothesized that anatomic factors such as body mass index (BMI) and the pelvic diameter would impact surgeon perception of difficulty.…”

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confidence: 99%

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Increased body mass index is associated with operative difficulty during robot‐assisted radical prostatectomy

et al. 2021

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Objective: This study aimed to identify factors associated with surgeon perception of robot-assisted radical prostatectomy (RARP) difficulty.Patients and Methods: This study surveyed surgeons performing RARP between 2017 and 2018 and asked them to rate operative conditions and difficulty as optimal, good, acceptable, or poor. These answers were stratified as optimal or suboptimal for this study. Associations between surgeon responses and variables hypothesized to affect surgical difficulty, including anatomic factors such as pelvic diameter and prostate volume:pelvic diameter ratio, were assessed.Results: Between November 2017 and September 2018, a total of 100 patients were prospectively enrolled in the study of which 58 cases were rated as optimal and 42 were rated as suboptimal. Of the evaluated variables, only increasing clinical T stage (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.03-2.15, p = 0.03) and increasing body mass index (BMI) (OR 1.14, 95% CI 1.03-1.26, p = 0.01) were associated with increased difficulty; 90-day complication rates were similar between the optimal and suboptimal cohorts (17.3% vs. 23.8%, respectively; p = 0.5). The number of patients with previous surgery, pelvic diameter, and prostate size:pelvic diameter ratio were not significantly different between cohorts (p > 0.05 for all). Operative time (ρ = 0.23, p = 0.02) and estimated blood loss (EBL) (ρ = 0.38, p = 0.0001) were correlated with suboptimal difficulty. Conclusion:The factors associated with surgeon-reported RARP difficulty were patient BMI and clinical T stage among surgeons with significant RARP experience. These data should be incorporated into surgical decision making and patient counseling prior to performing a RARP.

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“…Previous studies identified several variables to predict the difficulty of rectal resections. Sex, BMI, tumour size and location, nCRT and co‐morbidity, anastomotic height, histopathological features, surgeon experience and anatomical dimensions of the pelvis were reported to be risk factors for conversion to open surgery, duration of surgery, CRM positivity and postoperative morbidity. Several MRI pelvimetric parameters have been investigated previously; however, the results were inconsistent owing to differences in sample size, the racial composition of patient populations, variables measured, and definitions of surgical difficulty used across studies.…”

Section: Discussionmentioning

confidence: 99%

Prediction of surgical difficulty in minimally invasive surgery for rectal cancer by use of MRI pelvimetry

et al. 2020

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Background: Technical difficulties in rectal surgery are often related to dissection in a limited surgical field. This study investigated the clinical value of MRI pelvimetry in the prediction of surgical difficulty associated with minimally invasive rectal surgery. Methods: Patients with rectal cancer who underwent laparoscopic or robotic total mesorectal excision between 2005 and 2017 were reviewed retrospectively and categorized according to surgical difficulty on the basis of duration of surgery, conversion to an open procedure, use of the transanal approach, postoperative hospital stay, blood loss and postoperative complications. Preoperative clinical and MRI-related parameters were examined to develop a prediction model to estimate the extent of surgical difficulty, and to compare anastomotic leakage rates in the low-and high-grade surgical difficulty groups. Prognosis was investigated by calculating overall and relapse-free survival, and cumulative local and distant recurrence rates. Results: Of 121 patients analysed, 104 (86⋅0 per cent) were categorized into the low-grade group and 17 (14⋅0 per cent) into the high-grade group. Multivariable analysis indicated that high-grade surgical difficulty was associated with a BMI above 25 kg/m 2 (odds ratio (OR) 4⋅45, P = 0⋅033), tumour size 45 mm or more (OR 5⋅42, P = 0⋅042), anorectal angle 123 ∘ or more (OR 5⋅98, P = 0⋅028) and pelvic outlet less than 82⋅7 mm (OR 6⋅62, P = 0⋅048). All of these features were used to devise a four-variable scoring model to predict surgical difficulty. In patients categorized as high grade for surgical difficulty, the anastomotic leakage rate was 53 per cent (9 of 17 patients), compared with 9⋅6 per cent (10 of 104) in the low-grade group (P < 0⋅001). The high-grade group had a significantly higher local recurrence rate than the low-grade group (P = 0⋅002). Conclusion: This study highlights the impact of clinical variables and MRI pelvimetry in the prediction of surgical difficulty in minimally invasive rectal surgery.

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Factors Influencing Difficulty of Laparoscopic Abdominoperineal Resection for Ultra-Low Rectal Cancer

Cited by 12 publications

References 28 publications

Assessing surgical difficulty in locally advanced mid–low rectal cancer: the accuracy of two MRI‐based predictive scores

Assessing surgical difficulty in locally advanced mid–low rectal cancer: the accuracy of two MRI‐based predictive scores

Increased body mass index is associated with operative difficulty during robot‐assisted radical prostatectomy

Prediction of surgical difficulty in minimally invasive surgery for rectal cancer by use of MRI pelvimetry

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