Quality of laparoscopic total mesorectal excision: results from a single institution in China.
OBJECTIVE
Incomplete total mesorectal excision (TME) may lead to local recurrence. Factors predicting suboptimal quality of laparoscopic TME have not been well documented. The aim of the prospective observational study was to evaluate factors influencing the quality of laparoscopic TME.


METHODS
Patients undergoing laparoscopic TME for rectal cancer between October 2012 and March 2013 were included. Uni- and multivariate logistic analysis were performed to identify factors independently predicting the suboptimal quality of laparoscopic TME.


RESULTS
A total of 52 patients undergoing laparoscopic TME for rectal cancer were included for analysis. Mesorectal resection was complete in 71.2%, nearly complete in 17.3%, and incomplete in 11.5%. Factors found to be significantly related to suboptimal TME in univariate analysis were as follows: BMI ≥ 25 kg/ cm2 (OR = 11.79, 95% CI: 2.88-48.25; p = 0.003) and advanced tumor stage (pT3/4) (OR = 1.90, 95% CI: 1.41-100.00; p = 0.023). Multivariate analysis identified BMI ≥ 25 kg/m2 (OR = 21.05, 95%CI: 3.26-136.06; p = 0.010), advanced tumor stage (pT3/4) (OR = 19.03, 95% CI: 1.55-233.88; p = 0.021) and neoadjuvant radiochemotherapy (OR = 29.76, 95% CI: 1.65-537.93; p = 0.022) as factors that were independently related to suboptimal TME.


CONCLUSIONS
Laparoscopic TME is feasible with the quality of mesorectal excision which was influenced by patient-, tumor-, and treat- ment-related factors.
Haijun
H
Deng
Hongyuan
H
Chen
Liying
L
Zhao
Zhiyong
Z
Shen
Yanan
Y
Wang
Xiaoliang
X
Lan
Qi
Q
Xue
Hao
H
Liu
Guoxin
G
Li
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D059186:Chemoradiotherapy, Adjuvant / Q000592:standards; D002681:China; D005260:Female; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000592:standards*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000592:standards; D009367:Neoplasm Staging; D016017:Odds Ratio; D010865:Pilot Projects; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome