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Impact of the approach on conversion to open surgery during minimally invasive restorative total mesorectal excision for rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The aim of this study is to explore the impact of the approach on conversion in patients undergoing minimally invasive restorative total mesorectal excision within a single unit.

Methods

A retrospective cohort study was conducted. Patients with rectal cancer undergoing minimally invasive restorative total mesorectal excision between January 2006 and June 2020 were included. Subjects were classified according to the presence or absence of conversion. Baseline variables and short-term outcomes were compared. Regression analyses were conducted to assess the relationship between the approach and conversion.

Results

During the study period, 318 patients underwent a restorative proctectomy. Of these, 240 met the inclusion criteria. Robotic and laparoscopic approaches were undertaken in 147 (61.3%) and 93 (38.8%) cases, respectively. A transanal approach was utilised in 62 (25.8%) cases (58.1% in combination with a robotic transabdominal approach). Conversion to open surgery occurred in 30 cases (12.5%). Conversion was associated with an increased overall complication rate (P = 0.003), surgical complications (P = 0.009), superficial surgical site infections (P = 0.02) and an increased length of hospital stay (P = 0.006). Robotic and transanal approaches were both associated with decreased conversion rates. The multiple logistic regression analysis, however, showed that only a transanal approach was independently associated with a lower risk of conversion (OR 0.147, 0.023–0.532; P = 0.01), whilst obesity was an independent risk factor for conversion (OR 4.388, 1.852–10.56; P < 0.00).

Conclusions

A transanal component is associated with a reduced conversion rate in minimally invasive restorative total mesorectal excision, regardless of the transabdominal approach utilised. Larger studies will be required to confirm these findings and define which subgroup of patients could benefit from transanal component when a robotic approach is undertaken.

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Author information

Author notes

  1. José Tomás Larach and Joseph Kong are co-first authors.

  2. Satish K. Warrier and Alexander G. Heriot are co-senior authors.

Authors and Affiliations

  1. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia

    José Tomás Larach, Joseph Kong, Julie Flynn, Timothy Wright, Helen Mohan, Peadar S. Waters, Jacob J. McCormick, Satish K. Warrier & Alexander G. Heriot

  2. Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia

    José Tomás Larach, Joseph Kong, Julie Flynn, Satish K. Warrier & Alexander G. Heriot

  3. Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile

    José Tomás Larach

  4. General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia

    Jacob J. McCormick, Satish K. Warrier & Alexander G. Heriot

  5. Central Clinical School, Monash University, Melbourne, Australia

    Joseph Kong & Satish K. Warrier

Authors
  1. José Tomás Larach
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Contributions

Alexander Heriot, Satish Warrier and Jacob McCormick were amongst the surgeons who performed the procedures. Alexander Heriot and Satish Warrier administered the project and guided the research. José Tomás Larach, Joseph Kong, Julie Flynn, Timothy Wright, Peadar Waters and Helen Mohan constructed the database and performed the statistical analyses. José Tomás Larach, Joseph Kong, Julie Flynn, Timothy Wright, Peadar Waters and Helen Mohan wrote the main manuscript. All the authors contributed significantly with the text revisions and manuscript editing. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Satish K. Warrier.

Ethics declarations

Ethics approval

Institutional Review Board ethics approval was obtained from both sites. Reference numbers are PMCC-2021–252498 and EH-2021-688. Informed consent regarding the surgical approach was obtained from all the participants.

Conflict of interest

Satish Warrier is a proctor for Intuitive Surgical. The other authors declare that they have no conflict of interest.

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Larach, J.T., Kong, J., Flynn, J. et al. Impact of the approach on conversion to open surgery during minimally invasive restorative total mesorectal excision for rectal cancer. Int J Colorectal Dis 38, 83 (2023). https://doi.org/10.1007/s00384-023-04382-0

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