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.
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 from 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.
Multivariate analysis showed that BMI (P < .0001), tumor distance from 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 from 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).
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.