Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: narrow pelvis is not a contraindication

This study aims to evaluate the clinical and anatomical factors, particularly pelvic dimensions that influence the difficulty of performing laparoscopic anterior resection for rectal cancer. We studied 50 consecutive patients who underwent laparoscopic anterior resection with double-stapling technique (DST) anastomosis for rectal cancer between January 2006 and February 2010. Staging was performed by computed tomography. Five pelvic dimensions (anteroposterior and transverse diameters of pelvic inlet and outlet, and pelvic depth) were measured using three-dimensional volume-rendering images. We also examined a number of other clinical characteristics, including gender, history of laparotomy, body mass index (BMI), operator, tumor location, tumor depth, nodal involvement, and tumor diameter. Univariate and multivariate analyses were performed to determine the predictive significance of these variables on surgical difficulty based on operative time and intraoperative blood loss. Males had significantly shorter pelvic inlets and outlets and significantly greater pelvic depth than females. However, gender did not significantly affect surgical outcomes, although males did tend to experience greater blood loss. Maximum tumor diameter (p = 0.014), BMI (p = 0.001), operator (p < 0.001), and tumor location (p = 0.009) were independent predictors of operative time, which, in turn, was related to intraoperative blood loss (p < 0.001). Maximum tumor diameter, BMI, operator experience, and tumor location can be used to predict the operative time required to complete laparoscopic anterior resection with DST anastomosis for rectal cancer, with no correlations between pelvic dimensions and operative time. The difficulty of the procedure was not related to patients' pelvic dimensions, which led us to conclude that narrow pelvis is not a contraindication for this surgery. Based on these results, we suggest that laparoscopic anterior resection should be performed by experienced surgeons in patients with large tumors, high BMI, and/or extraperitoneal rectal cancer.