Obesity and narrow pelvis prolong the operative time in conventional laparoscopic rectal cancer surgery, but not in a two-team transanal total mesorectal excision approach
Obesity and narrow pelvis prolong the operative time in conventional laparoscopic rectal cancer surgery, but not in a two-team transanal total mesorectal excision approach
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DOI：
10.1111/ases.13134
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发表时间：
2022-10-04
影响因子：
1
通讯作者：
Kakeji, Yoshihiro
中科院分区：
文献类型：
--
作者：
Hasegawa, Hiroshi;Matsuda, Takeru;Kakeji, Yoshihiro
目的：盆腔狭窄、肿瘤直径和肥胖已被报道为与传统的腹腔镜下前切除术(Lap-LAR)困难相关的临床变量。两组经肛门全直肠系膜切除术(TaTME)同时进行经腹和全直肠系膜切除术，可能会减少与这些因素相关的困难。本研究旨在阐明传统LAP-LAR和两组TTME所需时间较长的相关因素。方法：对52例直肠癌LapLAR患者和35例TaTME患者进行分析。结果：LAP-LAR组TME时间与产科结合率(R-2=0.098，P.024)和BMI(R-2=0.307，P<；.001)有高度显著的相关性，而TAP-LAR组无显著相关性。LAP-LAR组男性患者骨盆狭窄、BMI高于女性患者的TME时间(213分钟比172分钟，P=0.021)，而TaTME组男性患者和女性患者的TME时间(122分钟比108分钟，P=.451)无差异。TaTME组的TME时间明显短于Lap-LAR组(121分钟对197分钟，P<；.001)。结论：与传统的LAP-LAR方法相比，两组TaTME方法提供了更短的TME时间，无论骨盆大小和体重指数。
Purpose: Narrow pelvis, tumor diameter, and obesity have been reported as clinical variables correlated with the difficulty of conventional laparoscopic low anterior resection (Lap-LAR). A two-team transanal total mesorectal excision (TaTME) approach where the transabdominal and TaTME are performed simultaneously might reduce the difficulty associated with these factors. This study aimed to clarify the factors associated with the longer time required for TME (TME time) in conventional Lap-LAR and a two-team approach for TaTME.Methods: We analyzed 52 patients with rectal carcinoma treated with LapLAR and 35 patients treated with TaTME. We performed simple linear regression analysis to assess the association between TME time and bony pelvic size using 3D pelvimetry, longest tumor diameter, and body mass index (BMI).Results: Linear regression analysis demonstrated a highly significant association between TME time and obstetric conjugate (R-2 = 0.098, P .024) and BMI (R-2 = 0.307, P < .001) in the Lap-LAR group, while no significant association was observed in the TaTME group. Male patients, who had a narrower bony pelvis and higher BMI than female patients, had longer TME time than female patients in the Lap-LAR group (213 minutes vs 172 minutes, P = .021), while the TME time of male and female patients did not differ in the TaTME group (122 minutes vs 108 minutes, P = .451). The TME time in the TaTME group was significantly shorter than that in the Lap-LAR group (121 minutes vs 197 minutes, P < .001).Conclusion: A two-team TaTME approach provided a shorter TME time compared to conventional Lap-LAR, regardless of pelvic size and BMI.