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A nomogram predicting the difficulty of laparoscopic surgery for rectal cancer

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Abstract

Purpose

This study aimed to identify the risk factors associated with performing a difficult laparoscopic radical resection of rectal cancer, and to establish a predictive nomogram to help individual clinical treatment decisions.

Methods

A total of 977 patients with rectal cancer who underwent laparoscopic radical resection between January 2014 and December 2016 were enrolled in this study. The difficulty of laparoscopic-assisted rectal resection (LARR) was defined according to the scoring criteria reported by Escal. A logistic regression analysis was performed to identify the variables that may affect the difficulty of LARR, and a nomogram predicting the surgical difficulty was created.

Results

A multivariate analysis demonstrated that a BMI > 28 kg/m2, the distance between the tumor and the anal margin ≤ 5 cm, the maximum transverse tumor diameter > 3 cm tumor, interspinous distance < 10 cm, history of abdominal surgery, and preoperative radiotherapy were independent risk factors and they were, therefore, included in the predictive nomogram for identifying a difficult LARR.

Conclusions

This study defined a difficult LARR and identified independent risk factors for a difficult operation and created a predictive nomogram for difficult LARR. This nomogram may facilitate the stratification of patients at risk for being associated with a difficult LARR for rectal cancer.

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Availability of data and materials

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Not applicable.

Funding

This study was supported by Fujian Minimally Invasive Medical Center Construction Project (No. 2017-171).

Author information

Author notes

  1. Chengwei Ye, Xiaojie Wang and Yanwu Sun contributed equally to the work.

Authors and Affiliations

  1. Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People’s Republic of China

    Chengwei Ye, Xiaojie Wang, Yanwu Sun, Yu Deng, Ying Huang & Pan Chi

  2. Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People’s Republic of China

    Xiaojie Wang, Yanwu Sun, Ying Huang & Pan Chi

  3. Department of Gastrointestinal Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, 1028 Anji South Road, 362000, Fujian Province, People’s Republic of China

    Chengwei Ye

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  1. Chengwei Ye
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  2. Xiaojie Wang
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  3. Yanwu Sun
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  4. Yu Deng
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Correspondence to Ying Huang or Pan Chi.

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Supplementary Information

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Supplementary file1 (DOC 16 KB)

595_2021_2338_MOESM2_ESM.tiff

Supplementary file2 (TIFF 372 KB) Figure S1. A interspinous distance (IS) 1B intertuberous distance (IT) obtained from the reformatted coronal T2-weighted image.

595_2021_2338_MOESM3_ESM.tiff

Supplementary file3 (TIFF 742 KB) Figure S2. Surgical video of a rectal cancer patient with a BMI 30 2A (left) The intraoperative anatomical hierarchy is not easily recognized, and separation is easy to bleed; 2B (right) Ultrasonic knife separation tends to develop more smoke than is normally observed during such surgery.

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Cite this article

Ye, C., Wang, X., Sun, Y. et al. A nomogram predicting the difficulty of laparoscopic surgery for rectal cancer. Surg Today 51, 1835–1842 (2021). https://doi.org/10.1007/s00595-021-02338-x

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  • DOI: https://doi.org/10.1007/s00595-021-02338-x

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