title: Factors Predicting Difficulty of Laparoscopic Low Anterior Resection for Rectal Cancer with Total Mesorectal Excision and Double Stapling Technique.
abstract: BACKGROUND
  Laparoscopic sphincter-preserving low anterior resection for rectal cancer is a surgery demanding great skill. Immense efforts have been devoted to identifying factors that can predict operative difficulty, but the results are inconsistent.
  
  
  OBJECTIVE
  Our study was conducted to screen patients' factors to build models for predicting the operative difficulty using well controlled data.
  
  
  METHODS
  We retrospectively reviewed records of 199 consecutive patients who had rectal cancers 5-8 cm from the anal verge. All underwent laparoscopic sphincter-preserving low anterior resections with total mesorectal excision (TME) and double stapling technique (DST). Data of 155 patients from one surgeon were utilized to build models to predict standardized endpoints (operative time, blood loss) and postoperative morbidity. Data of 44 patients from other surgeons were used to test the predictability of the built models.
  
  
  RESULTS
  Our results showed prior abdominal surgery, preoperative chemoradiotherapy, tumor distance to anal verge, interspinous distance, and BMI were predictors for the standardized operative times. Gender and tumor maximum diameter were related to the standardized blood loss. Temporary diversion and tumor diameter were predictors for postoperative morbidity. The model constructed for the operative time demonstrated excellent predictability for patients from different surgeons.
  
  
  CONCLUSIONS
  With a well-controlled patient population, we have built a predictable model to estimate operative difficulty. The standardized operative time will make it possible to significantly increase sample size and build more reliable models to predict operative difficulty for clinical use.
authors.affiliation: Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
authors.forename: Weiping
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
authors.forename: Qiken
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
authors.forename: Yongtian
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
authors.forename: Dechuan
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
authors.forename: Lai
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
authors.forename: Pengnian
authors.initials: P
authors.lastname: Qiu
authors.affiliation: Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
authors.forename: Lilong
authors.initials: L
authors.lastname: Tang
mesh_terms: D001003:Anal Canal / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008962:Models, Theoretical; D061646:Operative Time; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling