Abstract
Objetive: In this study, we addressed which factors, including endoscopic submucosal dissection (ESD)–related parameters, affect the difficulty of laparoscopic rectal surgery. Summary of background data: Endoscopic treatment for gastrointestinal cancer can cause inflammation, edema, and fibrosis formation in the surrounding tissue. Recently, we reported that preceding endoscopic treatment increased the volume of intraoperative blood loss and slightly prolonged the operative time of laparoscopic surgery for rectal cancer. Methods: We retrospectively reviewed 24 consecutive patients who underwent ESD followed by laparoscopic surgery for rectal cancer in our hospital. Short-term surgical outcomes were evaluated by intraoperative blood loss and operative time for laparoscopic surgery. The correlations between the surgical outcomes and preoperative parameter were analyzed by multiple linear regression analyses. Results: The patient cohort comprised 12 men and 12 women. The median distance between primary cancer and anal verge was 7 cm. The median procedure time of ESD was 120 minutes (21 available cases). Based on multiple linear regression analyses, the ESD procedure time (P = 0.007) and tumor location from the anal verge (P = 0.046) were independently predictive of intraoperative blood loss. On the other hand, only tumor location was found to be an independent predictor of surgical time (P = 0.014). Conclusions: A long session of ESD for rectal cancer may make subsequent laparoscopic surgery difficult based on intraoperative blood loss.
Highlights
The patient cohort comprised 12 men and 12 women
We recently demonstrated that preceding endoscopic treatment increased the volume of intraoperative blood loss and slightly prolonged the operative time for laparoscopic surgery for early rectal cancer.[6]
Electrocoagulation injury to the rectal wall induced by endoscopic treatment may lead to transmural burn, causing inflammation of the mesorectum and subsequent fibrosis in the surrounding tissue, which is considered a possible explanation for the results
Summary
We retrospectively reviewed 24 consecutive patients who underwent ESD followed by laparoscopic surgery for rectal cancer in our hospital. Short-term surgical outcomes were evaluated by intraoperative blood loss and operative time for laparoscopic surgery. We retrospectively reviewed consecutive patients with early rectal cancer who underwent ESD and subsequent surgery via a laparoscopic approach between November 2012 and June 2020 at the Department of Surgical Oncology, The University of Tokyo Hospital. Patients in whom ESD was discontinued for technical reasons during the procedure were included, whereas patients treated by abdominoperineal resection, those who underwent combined resection of multiple colorectal cancers, and those who needed conversion to open laparotomy were excluded. The indications and procedure of ESD for rectal lesions were described previously.[2,6] Pathologic findings of ESD specimens indicating noncurative, namely, oncologically insufficient treatment, included cancer-positive margin, extensive submucosal invasion (!1 mm; pT1b), lymphatic and venous infiltration, dedifferentiated component, and grade 2 or 3 budding based on the Japanese Society for Cancer of the Colon and Rectum guidelines.[5]
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