Technical difficulty grade score for the laparoscopic approach of rectal cancerReport as inadecuate




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International Journal of Colorectal Disease

, Volume 23, Issue 5, pp 469–475

A single institution pilot studyFirst Online: 09 January 2008Accepted: 13 December 2007

Abstract

IntroductionWe aimed to categorize laparoscopic rectal resections according to technical difficulty to standardize learning purposes and stratify results, making future studies more comparable.

Materials and methodsFifty patients undergoing a laparoscopic total mesorectal excision were prospectively followed. Four preoperatively known facts gender, body mass index BMI, tumor localization, and preoperative radiation therapy were compared to four operative outcomes operation time, blood loss, a visual analogue score VAS for difficulty rewarded by the surgeon, and oncological radicality of the procedure.

ResultsOperating time for male and female patients was 257 vs. 245 min P = 0.229, blood loss was 300 vs. 300 ml P = 0.309, the VAS was 8 vs. 6 P < 0.001, and radicality was 93% vs. 91% P = 0.806. Operating time was 215, 250, and 305 min for high, mid, and low tumors Spearman −0.44; P = 0.02, respectively. Blood loss was 105, 300, and 600 ml Spearman −0.38; P = 0.01. Lower tumors were rewarded a higher VAS Spearman −0.57; P < 0.001 and were less often radically resected Spearman 0.32; P = 0.026. Operating time for irradiated and nonirradiated patients was 277 vs. 225 min P = 0.008, blood loss was 500 vs. 150 ml P = 0.006, the VAS was 7 vs. 5 P < 0.001, and radicality was 79% vs. 100% P = 0.046. Operating time was 240 min for BMI 25–30 and 253 min for BMI > 30 Spearman 0.13; P = 0.391. Blood loss was 150 ml for BMI 25–30 and 500 ml for BMI > 30 Spearman 0.38; P = 0.01. Higher BMIs were rewarded a higher VAS Spearman 0.06; P = 0.704. BMI had no correlation to radicality of the procedure Spearman −0.12; P = 0.402. There was an association between technical difficulty score and operation time P = 0.007, blood loss P < 0.001, VAS P < 0.001, and radicality of surgery P = 0.043.

ConclusionLaparoscopic surgery in male, irradiated, and obese patients with lower tumors seemed more difficult. A categorization according to technical difficulty, to preoperatively predict difficulty of the procedure, was found feasible.

KeywordsTotal mesorectal excision Learning curve Laparoscopy Rectal cancer  Download fulltext PDF



Author: A. A. F. A. Veenhof - A. F. Engel - D. L. van der Peet - C. Sietses - W. J. H. J. Meijerink - E. S. M. de Lange-

Source: https://link.springer.com/article/10.1007/s00384-007-0433-5







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