- Tytuł:
- Predictors of surgical difficulty in laparoscopic total mesorectal excision
- Autorzy:
-
Kong, Joseph C.
Prabhakaran, Swetha
Fraser, Alison
Warrier, Satish
Heriot, Alexander G. - Tematy:
-
laparoscopic surgery
laparoscopic total mesorectal excision
predictors of difficulty
total mesorectal excision - Pokaż więcej
- Wydawca:
- Index Copernicus International
- Powiązania:
- https://bibliotekanauki.pl/articles/58435150.pdf Link otwiera się w nowym oknie
- Opis:
- Introduction: Concerns have been raised regarding the oncological safety of laparoscopic total mesorectal excision (TME) as compared to an open approach. Aim: This study aimed to identify risk factors for surgically difficult laparoscopic TME. Material and methods: All consecutive laparoscopic rectal cancer cases were included from a prospectively maintained colorectal cancer database. The primary outcome was to identify risk factors for surgically difficult TME. A Surgical Difficulty Risk Score (SDRS) between 0 and 6 was calculated for each case with cases achieving an SDRS of 2 or greater being deemed as surgically difficult. Results: A total of 2795 consecutive cases of laparoscopic TME were identified, with 464 (16.6%) surgically difficult cases. Univariate analysis found that operating in the male pelvis, performing abdomino-perineal resections, Hartmann’s procedures, and proctocolectomies were all significantly associated with higher operative difficulty (P < 0.001). A higher nodal stage of cancer (P = 0.046), and the resection of another organ (P = 0.003) were significantly associated with higher surgical difficulty. On multivariate analysis, a female pelvis was associated with a favorable laparoscopic resection (Odds ratio [OR] 0.54, 95% CI 0.43–0.67, P < 0.001), whereas patients who had another organ resection (OR 2.6, 95% CI 1.53–4.42, P < 0.001), nodal positivity (OR 1.37, 95% CI 1.11–1.69, P = 0.003), and high ASA scores had more difficult surgeries. Discussion: Predictive factors for surgically difficult laparoscopic TME include male gender, high ASA scores, mid and low rectal cancer, positive nodal stage, and resection of another organ at time of surgery.
- Dostawca treści:
- Biblioteka Nauki
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