Preoperative Evaluation Of The Difficulty In Laparoscopic Rectal Cancer Surgery

Objective:Through retrospective study,the factors affecting the difficulty of laparoscopic radical resection for rectal cancer were analyzed.The method of evaluating the difficulty of endoscopic rectal cancer radical resection was studied and developed.To guide the clinical preparation,for patients with more difficult surgery,we can choose a more experienced physician,or recommend new adjuvant chemotherapy.Method:A retrospective analysis of 241 cases of laparoscopic rectal cancer anterior resection in our hospital from March 2013 to October 2018 was performed retrospectively.The operation time was used as an evaluation index for the difficulty of surgery.Analyze the relationship between relevant influencing factors and operation time.Influencing factors include patient analysis of patient basic information(age,gender),anatomical factors(pelvic morphology,abdominal visceral fat area,subcutaneous fat area,BMI,history of abdominal surgery),tumor factors(tumor maximum diameter,distance from anus,TNM)Staging),laboratory indicators(clotting time,fibrinogen)and other factors have an impact on the degree of difficulty.Surgical time was used as the evaluation index of surgical difficulty.Firstly,single factor analysis was used for preliminary screening: continuous variables were analyzed by Spearman correlation for single factor analysis;categorical variables were tested by independent sample t test.The selected factors(P<0.05)were multivariately analyzed by multiple linear regression method,and a predictive model of operation time was established.Results:The results of this study: 1,continuous variables by Spearman correlation for univariate analysis,statistically significant: BMI(P = 0.031),anal margin(P < 0.001),abdominal anteroposterior diameter(P = 0.016),VFA(P=0.025),abdominal anteroposterior diameter/inlet anteroposterior diameter(P=0.002),abdominal transverse diameter/inlet transverse diameter(P<0.001),acetabular diameter(P=0.041),and appendix diameter(P)=0.049).2.The categorical variables were tested by independent sample t test,and no statistically significant indicators were found.3.Multivariate analysis was performed by multiple linear regression.The results showed that the anal margin(P<0.001),the diameter of the appendix(P=0.005),the anteroposterior diameter of the abdomen/inlet anterior and posterior diameter(P)=0.022),abdominal transverse diameter / inlet transverse diameter(P = 0.048).According to the characteristics of multiple linear regression equations,we can obtain the following prediction models: operation time = 58.678-5.288×(tumor position)+ 47.705 ×(abdominal anteroposterior diameter / entrance anteroposterior diameter)+34.757 ×(abdominal transverse diameter / inlet transverse diameter))+ 0.709 ×(the acetabular diameter).Conclusion:The technical difficulty factors affecting laparoscopic anterior resection of rectal cancer include: anal margin,appendix diameter,abdominal anteroposterior diameter/inlet anteroposterior diameter,abdominal transverse diameter/inlet Cross diameter.