Evaluation Of Related Factors Influencing Technical Difficulty Of Laparoscopic Anterior Resection Of Rectal Cancer

Objective: To explore the factors related to the difficulty of laparoscopic anterior resection for rectal cancer,so as to help surgeons identify potential surgical risks and formulate a complete preoperative plan.Methods: Clinical data of 75 patients with rectal cancer from January 2016 to April2018 were retrospectively analyzed,and these patients were treated by the same surgical treatment group in the general surgery department of original Shenyang Military Region General Hospital.These patients were routinely measured for height and weight before surgery,and abdominal CT imaging also needed to be done.The body mass index(BMI)of patients can be calculated according to the measured values of height and weight.Visceral fat area,ischial spine diameter,mesorectal fat area and mesorectal fat area ratio in each patient can be obtained from abdominal CT imaging data combined with Image J software.Preoperative enteroscopy and post-operative pathological reports can provide us with some information about the distance from the tumors to the anal margin,the size of tumors,the depth of tumor invasion,lymph node metastasis and TNM staging.To analyze the impact of these clinical indicators on the operation time and intraoperative blood loss of laparoscopic anterior resection of rectal cancer,and to use the operation time and intraoperative blood loss as a measure of the degree of difficulty of operation,so as to determine the influence factors and predictive indicators related to the difficulty of operation.Results: The median value of operative time and intraoperative blood loss in 75 patients who underwent laparoscopic anterior resection of rectal cancer were 150(80-220)min and 50(10-200)ml respectively.When operation time was used as a measure of the difficulty of the operation,univariate analysis showed that gender,body mass index,visceral fat area,mesorectal fat area,mesorectal fat area ratio,distance from tumor toanal margin and lymph node metastasis were correlated with operation time(P=0.024?0.033?0.028?0.008?0.004?0.015?0.043),while age,ischial spine diameter,tumor diameter,depth of invasion and TNM stage were not correlated with operation time(P>0.05),and multivariate linear regression analysis showed that mesorectal fat area ratio and the distance from tumor to anal margin were closely related to operation time(P=0.031 ? 0.028).When intraoperative blood loss was used as a measure of the difficulty of operation,univariate analysis showed that the distance from the tumor to the anal margin,the diameter of the tumor,lymph node metastasis and TNM stage were correlated with intraoperative blood loss(P=0.008?0.010?0.019?0.009),while gender,age,body mass index,visceral fat area,ischial spine diameter,mesorectal fat area,mesorectal fat area ratio and depth of tumor invasion were not correlated with intraoperative blood loss(P>0.05),and multivariate linear regression analysis showed that the distances from tumors to anal margins and TNM stage were closely related to intraoperative blood loss(P=0.002?0.049).Conclusions: The technical difficulty of laparoscopic anterior resection of rectal cancer is related to many factors,the operative time and intraoperative blood loss are reliable criteria for evaluating the surgical difficulty.Mesorectal fat area ratio and the distance between tumors and anal margin are closely related to the operation time of laparoscopic anterior resection of rectal cancer.The distance between tumors and anal margin and TNM stage of tumors are closely related to the blood loss of laparoscopic anterior resection of rectal cancer.Mesorectal fat area ratio and the distance from tumor to anal margin are more reliable indicators for evaluating the technical difficulty of laparoscopic anterior resection of rectal cancer.