title: Factors Influencing Difficulty of Laparoscopic Abdominoperineal Resection for Ultra-Low Rectal Cancer.
abstract: OBJECTIVE
  Our current study was conducted to identify patients' anatomic, pathologic, and clinical factors to predict difficulty of performing laparoscopic abdominoperineal resection for ultra-low rectal cancer.
  
  
  METHODS
  Records of 117 consecutive patients with rectal cancer 2 to 5 cm from the anal verge were retrospectively reviewed. Using univariate and multivariate linear or logistic regression models, standardized operative time and blood loss, as well as postoperative morbidity were utilized as endpoints to screen patients' multiple variables to predict operative difficulty.
  
  
  RESULTS
  Multivariate linear regression analysis showed body mass index (BMI) (estimate=0.07, P=0.0056), interspinous distance (estimate=-0.02, P=0.0011), tumor distance from anal verge (estimate=-0.17, P=0.0355), prior abdominal surgery (estimate=0.51, P=0.0180), preoperative chemoradiotherapy (estimate=0.67, P=0.0146), and concurrent diseases (hypertension and/or diabetes mellitus) (estimate=0.49, P=0.0122) are predictors for standardized operative time. Age (estimate=0.02, P=0.0208) and concurrent diseases (estimate=0.43, P=0.0476) were factors related to standardized blood loss. BMI (estimate=0.15, P=0.0472) was the only predictor for postoperative morbidity based on logistic regression analysis.
  
  
  CONCLUSIONS
  Age, BMI, interspinous distance, tumor distance from anal verge, prior abdominal surgery, preoperative chemoradiotherapy, and concurrent diseases influence the difficulty of performing laparoscopic abdominoperineal resection for ultra-low rectal cancer. Standardized operative time allows researchers to amass samples by pooling data from all published studies, thus building reliable models to predict operative difficulty for clinical use.
authors.affiliation: Departments of *Colorectal Surgery †Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
authors.forename: Qiken
authors.initials: Q
authors.lastname: Li
authors.forename: Dechuan
authors.initials: D
authors.lastname: Li
authors.forename: Lai
authors.initials: L
authors.lastname: Jiang
authors.forename: Pengnian
authors.initials: P
authors.lastname: Qiu
authors.forename: Zhixuan
authors.initials: Z
authors.lastname: Fu
authors.forename: Lilong
authors.initials: L
authors.lastname: Tang
authors.forename: Weiping
authors.initials: W
authors.lastname: Chen
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000367:Age Factors; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies