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.

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 Lap-LAR 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 (R2  = 0.098, P = .024) and BMI (R2  = 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.