Predicting the pathological features of the mesorectum before the laparoscopic approach to rectal cancer
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Pelvic anatomy and tumour features play a role in the difficulty of the laparoscopic approach to total mesorectal excision in rectal cancer. The aim of the study was to analyse whether these characteristics also influence the quality of the surgical specimen. We performed a prospective study in consecutive patients with rectal cancer located less than 12 cm from the anal verge who underwent laparoscopic surgery between January 2010 and July 2013. Exclusion criteria were T1 and T4 tumours, abdominoperineal resections, obstructive and perforated tumours, or any major contraindication for laparoscopic surgery. Dependent variables were the circumferential resection margin (CMR) and the quality of the mesorectum. Sixty-four patients underwent laparoscopic sphincter-preserving total mesorectal excision. Resection was complete in 79.1 % of specimens and CMR was positive in 9.7 %. Univariate analysis showed tumour depth (T status) (P = 0.04) and promontorium–subsacrum angle (P = 0.02) independently predicted CRM (circumferential resection margin) positivity. Tumour depth (P < 0.05) and promontorium–subsacrum axis (P < 0.05) independently predicted mesorectum quality. Multivariate analysis identified the promontorium–subsacrum angle (P = 0.012) as the only independent predictor of CRM. Bony pelvis dimensions influenced the quality of the specimen obtained by laparoscopy. These measurements may be useful to predict which patients will benefit most from laparoscopic surgery and also to select patients in accordance with the learning curve of trainee surgeons.
KeywordsRectal cancer Total mesorectal excision Laparoscopy Pelvimetry Quality of mesorectum Circumferential resection margin
The authors thank Ms. C. Newey for her help and support in the English language revision of this article. This study has been supported by a Grant of Instituto de Salud Carlos III (File number: PS09/1437).
Authors Sonia Fernández Ananín, Eduardo M Targarona, Carmen Martinez, Juan Carlos Pernas, Diana Hernández, Ignasi Gich, Francesc J. Sancho and Manuel Trias have no conflicts of interest or financial ties to disclose.
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