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

Larach, JT; Kong, J; Flynn, J; Wright, T; Mohan, H; Waters, PS; McCormick, JJ; Warrier, SK; Heriot, AG

Author(s): Larach, JT; Kong, J; Flynn, J; Wright, T; Mohan, H; Waters, PS; McCormick, JJ; Warrier, SK; Heriot, AG;
Details: Publication Year 2023-03-27,Volume 38,Issue #1,Page 83
Journal Title: International Journal of Colorectal Disease
Publication Type: Research article
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.
Publisher: Springer Nature
Keywords: Humans; Conversion to Open Surgery/adverse effects; Retrospective Studies; Treatment Outcome; *Laparoscopy/adverse effects; *Rectal Neoplasms/surgery/complications; Postoperative Complications/etiology; Rectum/surgery; Conversion; Laparoscopic; Rectal cancer; Robotic; Total mesorectal excision; Transanal
Department(s): Surgical Oncology
PubMed ID: 36971883
Publisher's Version: https://doi.org/10.1007/s00384-023-04382-0
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-06-27 07:59:02

Last Modified: 2023-06-27 07:59:22