Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer

Background. Although the laparoscopic approach is accepted for the treatment of colon cancer, its value for low rectal cancer is unknown. The purpose of this study was to evaluate the influence of patient and tumor factors, particularly pelvic dimensions, on the difficulties in laparoscopic total mesorectal excision (TME) for low rectal cancer. Methods. Seventy-nine consecutive patients underwent laparoscopic TME with intracorporeal rectal transection and double stapling technique (DST) anastomosis for low rectal cancer. Gender body mass index (BMI), tumor diameter, tumor depth, tumor distance front the anal verge, preoperative chemoradiotherapy, and 5 pelvic dimensions (pelvic inlet, Pelvic outlet, length of sacrum, interspinous distance, and intertuberous distance) were analyzed as variables affecting the difficulties of laparoscopic TME. The dependent variables were pelvic operative time, which was defined as the time required for dissection of the rectum from the pelvis, intracorporeal transaction, and anastomosis. Other dependent variables were intraoperative blood loss, overall postoperative morbidity and anastomotic leakage. Univariate and multivariate analyses were performed to determine the predictive significance of variables. Results. Multivariate analysis showed that BMI (P < .0001), tumor distance front the anal verge (P = .0003), tumor depth (P = .0021), and pelvic outlet, (P = .0362) were independently predictive of pelvic operative time. Pelvic operative time was related to intraoperative blood loss (P < .0001.). The tumor distance front the anal verge (P = .0333, odds ratio [OR]: 1.06) was related to postoperative morbidity, and pelvic outlet was related to anastomotic leakage (P = .0305, OR: 1.13). Conclusion. BMI, tumor distance from the anal verge, tumor depth, and pelvic outlet were independent predictors for operative time and morbidity. These factors should be taken into account when planning laparoscopic TME. (Surgery 2009;146:483-9.)