A simple difficulty scoring system for laparoscopic total mesorectal excision.
Difficulty scoring system
Laparoscopy
Rectal cancer
Total mesorectal excision
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
16
03
2020
accepted:
25
06
2020
pubmed:
16
7
2020
medline:
28
4
2021
entrez:
16
7
2020
Statut:
ppublish
Résumé
The proposed difficulty scoring system (DSS) may aid in preoperative planning for laparoscopic total mesorectal excision (L-TME) for rectal cancer. Fifty-three patients [28 males; 59.0 (31.0-88.0) years of age] treated for rectal cancer at our institution from 2/2011-5/2018 were identified. "Difficult operation" (DO) was defined as the presence of ≥3 factors: operative time ≥320 min, estimated blood loss >250 ml, intraoperative complications, conversion to laparotomy, >2 stapler applications, incomplete TME quality, and/or subjective perceived difficulty. Univariate analysis and multivariate logistic regression model with backward elimination method were used to obtain a DSS which consists of two factors: sex (male = 1 and female = 0) and body mass index (BMI) (≥30 kg/m In univariate analysis, sex (p = 0.0217), BMI (p = 0.0026), American Society of Anesthesiologists (ASA) score (p = 0.0372), and magnetic resonance imaging transverse diameter (p = 0.0441) correlated to DO. Multivariate analysis revealed that sex and BMI were the most important risk factors for a DO [area under the receiver operating characteristic curve [AUC] = 0.7761, 95% CI = (0.6443-0.9080)]. Male patients with a BMI ≥ 30 kg/m A simplified DSS may be used preoperatively in preparation for L-TME.
Sections du résumé
BACKGROUND
The proposed difficulty scoring system (DSS) may aid in preoperative planning for laparoscopic total mesorectal excision (L-TME) for rectal cancer.
METHODS
Fifty-three patients [28 males; 59.0 (31.0-88.0) years of age] treated for rectal cancer at our institution from 2/2011-5/2018 were identified. "Difficult operation" (DO) was defined as the presence of ≥3 factors: operative time ≥320 min, estimated blood loss >250 ml, intraoperative complications, conversion to laparotomy, >2 stapler applications, incomplete TME quality, and/or subjective perceived difficulty. Univariate analysis and multivariate logistic regression model with backward elimination method were used to obtain a DSS which consists of two factors: sex (male = 1 and female = 0) and body mass index (BMI) (≥30 kg/m
RESULTS
In univariate analysis, sex (p = 0.0217), BMI (p = 0.0026), American Society of Anesthesiologists (ASA) score (p = 0.0372), and magnetic resonance imaging transverse diameter (p = 0.0441) correlated to DO. Multivariate analysis revealed that sex and BMI were the most important risk factors for a DO [area under the receiver operating characteristic curve [AUC] = 0.7761, 95% CI = (0.6443-0.9080)]. Male patients with a BMI ≥ 30 kg/m
CONCLUSIONS
A simplified DSS may be used preoperatively in preparation for L-TME.
Identifiants
pubmed: 32666360
doi: 10.1007/s10151-020-02285-8
pii: 10.1007/s10151-020-02285-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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