Laparoscopic Anterior Resection Research Articles

Effect of left colonic artery preservation on perfusion at the anastomosis in rectal cancer surgery evaluated with intraoperative ultrasound.

Intraoperative ultrasound was used to assess the flow velocity in the marginal vessel arch adjacent to the anastomosis, critical for evaluating the anastomotic blood supply. This technique also enabled us to investigate the potential effects of preserving the left colonic artery on the perfusion of the anastomosis. This prospective study included 40 rectal cancer patients who underwent laparoscopic anterior resection between January 2021 and January 2023. The length of the inferior mesenteric artery (IMA) was measured from its origin to the first branch, and the diameters of the mesenteric vessel IMA, left colonic artery (LCA), and marginal mesenteric artery (MMA) were recorded. Blood flow velocity and Doppler ultrasound waveforms of the MMA near the anastomosis were collected. Measurements were taken both before and after clamping the IMA using atraumatic forceps. The tardus parvus pattern of the MMA ultrasound waveforms was recorded to evaluate the hypoperfusion status of the anastomosis. The mean velocities of MMA were 47.9cm/s before clamping and 34.9cm/s after atraumatic clamping, indicating significant differences (p < 0.05). Thirteen patients (32.5%) exhibited a Tardus parvus pattern after IMA atraumatic clamping. Multivariate analysis revealed older age and LCA diameter as independent clinical predictors of the hypoperfusion status after IMA clamping. Preservation of the LCA may improve perfusion near the anastomosis during rectal cancer surgery. Older age and LCA diameter can be considered useful predictors of the mesenteric hypoperfusion status after IMA ligation. Intraoperative ultrasound can evaluate the perfusion of the MMA near the anastomosis. Chinese Clinical Trial Registry-Registration number: ChiCTR2000041475.

Intracorporal isoperistaltic linear colorectal “side-to-side” (overlap) anastomosis: invention concept and primary results

AIM: to present the primary experience of performing intracorporeal linear colorectal anastomosis using the “overlap” technique in laparoscopic anterior rectal resection. MATERIALS AND METHODS: the study presents the outcomes of intracorporeal linear “overlap” anastomosis in patients who underwent laparoscopic anterior rectal resection between October 2023 and February 2024. The results were evaluated based on various parameters including operation time, the postoperative morbidity rate (by Clavien-Dindo scale), conversion rates, hospital stay, quality of life by SF-36 questionnaire 30 days after surgery. RESULTS: the linear “overlap” anastomosis was done in 10 patients (5 females), aged 62.0 ± 9.03 years and BMI of 27.5 ± 7.2 kg/m2. No intraoperative complications occurred. One patient developed a seroma at the incision site (Clavien–Dindo I). The first bowel movement was at 1 (0–3) days after surgery. The post-op hospital stay was 5.7 ± 1.9 days. CONCLUSION: primary results demonstrate the simplicity and safety of intracorporeal linear “overlap” anastomosis technique. The further advanced study is justified.

SP6.11 - What the Doctor Said: Evaluation of Discharge Information to Inpatient Colorectal Patients

Abstract Aims To establish clarity of post operative information for patients for elective colorectal patients. To establish comprehensiveness of discharge information for elective colorectal patients. Methods 100 consecutive discharge summaries were collected from a busy elective colorectal unit. These were evaluated against NHS England’s discharge standards as well as a defunct local “After Care Advice’ form. Anonymous data were collated on Google Sheets and analysed. Results Patients had a median age of 68, with 54% being female. Operations ranged from EUA to exenteration with the most common operations being reversal of ileostomy (9%), laparoscopic right hemicolectomy (8%) and laparoscopic anterior resection (8%). The mode of length of stay was 9 days. Two patients were given the incorrect name of procedure on their discharge paperwork. 61% were not given details of investigations performed during admission with only 12% given details and timescales of tests to be performed on discharge. Follow up details were relayed to 77% on their discharge summaries. Of those that has wounds closed, 77% were not given details on how, with 97% receiving no wound care advice. Patients did not receive advice on return to activity (99%), bleeding (96%), anaesthetic limitations (100%) or driving (99%). Only 8% received information regarding VTE prophylaxis while 94% were not given infection advice. Despite these being colorectal operations, 94% did not receive any advice regarding bowel function or use of laxatives. Conclusions These results indicate that patients are not receiving adequate information regarding their time in hospital, their procedures or what to expect afterwards. This must improve.

Short-term outcomes of robotic tumor-specific mesorectal resection of rectal cancer: surgical techniques in mesorectal division using rolling division of the mesorectum.

This study aims to report our surgical techniques for robot-assisted laparoscopic anterior resection, specifically focusing on mesorectal division using rolling division of the mesorectum, and to elucidate short-term outcomes at a single institution. Tumor-specific mesorectal excision (TSME) is commonly performed for resection of a tumor located in the upper rectum. However, especially in a narrow pelvis, it is difficult to perform appropriate mesorectal division at an adequate distance from the tumor in robot-assisted laparoscopic anterior resection. Retrospective case series of patients with rectal cancer who underwent robot-assisted TSME using rolling division of mesorectum. Patient characteristics, perioperative clinical results, surgical and pathological details were recorded. A total of 198 patients underwent robot-assisted TSME for rectal cancer using rolling division of mesorectum between May 2019 and December 2023.The tumor was located in the upper rectum in 45 patients, middle rectum in 115 patients and lower rectum in 38 patients. The types of resections were 40 high anterior resection and 158 low anterior resections. The median operation time was 175 (range 109-310) min, and median mesorectal division time was 24 (range 15-45) min. Median blood loss was 3 (range 0-20) ml; no patients required blood transfusion. The overall complication rate of Clavien-Dindo classification grades I-IV was 7.1%. Anastomotic leakage was observed in two patients (1.0%) with grade III. There was no surgical mortality in this series. This robotic technique for anterior resection is a feasible and reliable procedure for achieving sufficient and safe TSME in this cohort.

Robotic versus laparoscopic anterior resection for the treatment of stage II and III sigmoid colon cancer: a propensity score-matched analysis.

Robot-assisted laparoscopic anterior resection is a novel technique. However, evidence in the literature regarding the advantages of robot-assisted laparoscopic surgery (RLS) is insufficient. The aim of this study was to compare the outcomes of RLS versus conventional laparoscopic surgery (CLS) for the treatment of sigmoid colon cancer. We performed a retrospective study at the Northern Jiangsu People's Hospital. Patients diagnosed with sigmoid colon cancer and underwent anterior resection between January 2019 to September 2023 were included in the study. We compared the basic characteristics of the patients and the short-term and long-term outcomes of patients in the two groups. A total of 452 patients were included. Based on propensity score matching, 212 patients (RLS, n = 106; CLS, n = 106) were included. The baseline data in RLS group was comparable to that in CLS group. Compared with CLS group, RLS group exhibited less estimated blood loss (P = 0.015), more harvested lymph nodes (P = 0.005), longer operation time (P < 0.001) and higher total hospitalization costs (P < 0.001). Meanwhile, there were no significant differences in other perioperative or pathologic outcomes between the two groups. For 3-year prognosis, overall survival rates were 92.5% in the RLS group and 90.6% in the CLS group (HR 0.700, 95% CI 0.276-1.774, P = 0.452); disease-free survival rates were 91.5% in the RLS group and 87.7% in the CLS group (HR 0.613, 95% CI 0.262-1.435, P = 0.259). Compared with CLS, RLS for sigmoid colon cancer was found to be associated with a higher number of lymph nodes harvested, similar perioperative outcomes and long-term survival outcomes. High total hospitalization costs of RLS did not translate into better long-term oncology outcomes.

A commentary on '"Dumpling suture method" versus traditional suture method of protective loop ileostomy in laparoscopic anterior rectal resection with specimen extraction through stoma incision: a retrospective comparative cohort study'.

A commentary on '"Dumpling suture method" versus traditional suture method of protective loop ileostomy in laparoscopic anterior rectal resection with specimen extraction through stoma incision: a retrospective comparative cohort study'.

Small Cell Carcinoma of Rectum - An Infrequent Aggressive Tumor

We report the case of a 63 year old man with small cell carcinoma of rectum. He presented with occasional rectal bleed, anal verge pain and generalized weakness. Colonoscopy revealed an ulcerated growth in proximal rectum. Endoscopic biopsy revealed poorly differentiated carcinoma. Laparoscopic anterior resection was done and histopathogical examination along with IHC confirmed small cell carcinoma(SCC). Colorectal SCC is a rare and aggressive tumor.

Surgical and Oncological Outcome of Laparoscopic Resection of Colorectal Cancers: A Single-Center Experience.

Laparoscopy is one of the major advances in surgery in the last 30 years and has many benefits. Although laparoscopy was initially used for resection of benign colon lesions, it is now widely used for colorectal cancer resections after strong evidence has confirmed its safety and efficacy. We aim to report both the surgical and oncological outcomes of our first series of laparoscopic colorectal cancer resections. In 2013, alaparoscopic colorectal resection service was established in northern Iraq at Zheen Hospital, Erbil. Data from all consecutive colorectal cancers were collected. Patients with locally advanced diseases and those who required emergency operations for bowel obstruction or perforation were excluded. We analyzed demographic, operative, postoperative, and histopathological data for all patients who were included in the study. A total of 124 patients with colorectal cancers presented to our unit between January 2013 and January 2023. Only 112 patients fulfilled the inclusion criteria and underwent laparoscopic resections. The median age of the patients was 54.5 years. The majority of patients were men (n=62; 55.4%). In 39 patients (35%), the cancer was located in the sigmoid; in 33 patients (29.5%) the cancer was in the rectum. Laparoscopic anterior resection was the most common procedure (n=50; 45%), followed by right hemicolectomy in 17cases (15.1%). The conversion rate to open surgery was 8% (nine cases). The most common causes of conversion to open surgery were dilated bowel loops and tumour adherence to other structures. The mean operative time was 190 minutes and the mean hospital stay was three days. No complications were reported in 94patients (84%). Among the complications, wound infection was seen in sevenpatients (7.8%). There were six anastomotic leaks (6.7%). The mean number of lymph nodes harvested was 13. In 70 patients (62.5%), the lymph node count was ≥12 with a median of 13. The mean distal resection margin was 6 cm and 2.5 cm for colon and rectal resections, respectively. This study reveals that laparoscopic resection for colorectal cancers is surgically practicable and safe with the benefits of a short hospital stay, adequate resection margins, and adequate lymph node yield.

Pelvic Floor Peritoneum Closure Reduces Severe Postoperative Complications in Rectal Cancer Patients After Laparoscopic Anterior Rectal Resection.

Laparoscopic anterior rectal resection (LAR) is a commonly performed surgery for rectal cancer patients. Pelvic floor peritoneum closure (PC), a vital procedure in conventional anterior rectal resection, is not routinely performed in LAR. A total of 1118 consecutive patients with rectal cancer receiving LAR were included in this retrospective study. Patients were allocated into the PC group and the non-PC group. The occurrence of postoperative complications was compared between the 2 groups. Influential factors in anastomotic leakage (AL) were explored using univariate and multivariate logistic regression. There was no difference between the groups in terms of baseline characteristics. The occurrence of postoperative complications was similar between the groups. The PC group had significantly shorter postoperative hospitalization and longer operation duration compared with the non-PC group. The occurrences of Clavien-Dindo (CD) III-IV complications, CD III-IV AL, and reoperation were significantly lower in the PC group than the non-PC group. PC and a protective ileostomy were independent protective factors for CD III-IV AL. PC could reduce the occurrence of CD III-IV complications, especially CD III-IV AL, and the rate of secondary surgery, especially in patients with a lower body mass index and patients who did not receive protective ileostomies.

Analysis of the incidence and symptomatology of low anterior resection syndrome after laparoscopic anterior resection for rectal cancer

Objective: This study aims to explore the temporal trend of Low Anterior Resection Syndrome (LARS) and its symptoms after laparoscopic anterior resection for rectal cancer. Methods: A retrospective cohort study design was employed. The study included primary rectal (adenocarcinoma) cancer patients who underwent laparoscopic anterior resection at Tongji Hospital, Huazhong University of Science and Technology, between January 1, 2010, and December 31, 2020. Complete medical records and follow-up data at 3, 6, 9, 12, and 18 months postoperatively were available for all patients. A total of 1454 patients were included, of whom 1094 (75.2%) were aged ≤65 years, and 597 (41.1%) were females. Among them, 1040 cases (71.5%) had an anastomosis-to-anus distance of 0-5cm, and 86 cases (5.9%) received neoadjuvant treatment. All patients completed the Chinese version of the LARS questionnaire and their LARS occurrence and specific symptom information were recorded at 3, 6, 9, 12, and 18 months postoperatively. Considering past literature and clinical experience, further subgroup analyses were performed to explore the potential impact factors on severe LARS, including anastomosis level, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and the presence of preventive stoma. Results: The occurrence rates of LARS at 3, 6, 9, 12, and 18 months postoperatively were 78.5% (1142/1454), 71.4% (1038/1454), 55.0% (799/1454), 45.7% (664/1454), and 45.7% (664/1454), respectively (χ2=546.180, P<0.001). No statistically significant difference was observed between the 12-month and 18-month time points (P>0.05). When compared with the symptoms at 3 months, the occurrence rates of gas incontinence [1.7% (24/1454) vs. 33.9% (493/1454)], liquid stool incontinence [3.9% (56/1454) vs. 41.9% (609/1454)], increased stool frequency [79.6% (1158/1454) vs. 95.9% (1395/1454)], stool clustering [74.3% (1081/1454) vs. 92.9% (1351/1454)], and stool urgency [46.5% (676/1454) vs. 78.7% (1144/1454)] in the LARS symptom spectrum were significantly alleviated at 12 months (all P<0.05) and remained stable beyond 12 months (all P>0.05). With the extension of postoperative time, the incidence rates of severe LARS exhibited a decreasing trend in different subgroups, of anastomosis level, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and the presence of preventive stoma, and reached stability at 12 months postoperatively (all P>0.05). Conclusion: LARS and its specific symptom profile showed a trend of gradual improvement over time up to 1 year postoperatively, and stabilized after more than 1 year. Increased stool frequency and stool clustering are the most common features of abnormal bowel dys function, which improve slowly after surgery.

Impact of standardising indocyanine green fluorescence angiography technique for visual and quantitative interpretation on interuser variability in colorectal surgery.

Intra-operative colonic perfusion assessment via indocyanine green fluorescence angiography (ICGFA) aims to address malperfusion-related anastomotic complications; however, its interpretation suffers interuser variability (IUV), especially early in ICGFA experience. This work assesses the impact of a protocol developed for both operator-based judgement and computational development on interpretation consistency, focusing on senior surgeons yet to start using ICGFA. Experienced and junior gastrointestinal surgeons were invited to complete an ICGFA-experience questionnaire. They subsequently interpreted nine operative ICGFA videos regarding perfusion sufficiency of a surgically prepared distal colon during laparoscopic anterior resection by indicating their preferred site of proximal transection using an online annotation platform (mindstamp.com). Six ICGFA videos had been prepared with a clinical standardisation protocol controlling camera and patient positioning of which three each had monochrome near infrared (NIR) and overlay display. Three others were non-standardised controls with synchronous NIR and overlay picture-in-picture display. Differences in transection level between different cohorts were assessed for intraclass correlation coefficient (ICC) via ImageJ and IBM SPSS. 58 clinicians (12 ICGFA experts, 46 ICGFA inexperienced of whom 23 were either finished or within one year of finishing training and 23 were junior trainees) participated as per power calculations. 63% felt that ICGFA should be routinely deployed with 57% believing interpretative competence requires 11-50 cases. Transection level concordance was generally good (ICC = 0.869) across all videos and levels of expertise (0.833-0.915). However, poor agreement was evident with the standardised protocol videos for overlay presentation (0.208-0.345). Similarly, poor agreement was seen for the monochrome display (0.392-0.517), except for those who were trained but ICG inexperienced (0.877) although even here agreement was less than with unstandardised videos (0.943). Colorectal ICGFA acquisition and display standardisation impacts IUV with this specific protocol tending to diminish surgeon interpretation consistency. ICGFA video recording for computational development may require dedicated protocols.

Alternative Approach in Colorectal Anastomotic Stricture: Bougie Dilatation

Dear Editor, Anostomotic stricture (AS) is seen in 2-30% of patients after colorectal surgery. Various factors such as tissue ischaemia, anastomotic leakage and radiotherapy have been suggested in its pathogenesis [1,2]. Endoscopic methods (balloon dilatation, bougie dilatation, stents, endoscopic electroincision), digital dilatation, surgical methods (stapler stricturoplasty, transanal circular stapler resection, transabdominal redo-anastomosis) and corticosteroids are used in AS [3,4]. Surgery is generally preferred in complete/near complete AS [1]. Stents; the benefit of stents in AS after oncological surgery has not been shown [3]. However, Philip BC Pangg et al. treated near-total AS non-operatively with the colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a hot lumen metallic stent [5]. We applied 3-stage bougie dilation to the patient with near complete anastomotic stricture. A 59-year-old female patient who underwent laparoscopic anterior resection due to sigmoid colon tumor was followed up with complaints of abdominal swelling, intermittent abdominal pain and difficulty in defecation. One month later, when colonoscopy was performed, near complete anastomotic stricture was observed. Bougie dilatation was performed with maloney flexible bougie dilators under wire guidance. Bougie dilatation was performed 3 times with fifteen days intervals. After the first (33, 36 and 42 F) and the second bougie dilatation (36, 42 F), the upper segment of the anastomotic stricture was reached by gastroscopy. After dilatation with a bougie (42, 45 F) for the third time, the colonoscope was easily passed through the anastomosis line to the upper segment. Six months later, colonoscopy was performed and the proximal part of the anastomosis was easily passed without the use of bougie dilators. Balloon dilatation is the first method used in AS. However, several repetitions are necessary for the success of the procedure. In addition, the risk of perforation increases when the stricture diameter is &lt;5 mm and length &gt;1 cm. The chances of success in AS are lower compared to bougie dilatation. Endoscopic electroincision is recommended in failure of balloon dilatation. Digital dilatation: used in distal anorectal anostamotic strictures. Corticosteroid application: very large studies are not available. Bougie dilatation in AS provides tactile feedback, allowing the amount of resistance to the passage of the dilator to be estimated and perforation to be avoided. Bougie dilatation method is simple, inexpensive and low risk of complications. Especially Maloney flexible silicone bougie minimise the risk of complications. Bougie dilatators can remain intact for many years and can be reused. But balloon dilatators are not reused. Surgical methods are used in 3-4% (complete/near complete AS) in the failure of endoscopic methods. But mortality risk is high [1,4-6]. Therefore, the alternative method of Philip BC Pang et al. can be applied [5]. However, due to limited endoscopic ultrasonography (EUS) centers, gradual dilatation can be performed with flexible bougie dilators in case of anastomosis stricture. Yours Sincerely

'Dumpling suture method' versus traditional suture method of protective loop ileostomy in laparoscopic anterior rectal resection with specimen extraction through stoma incision: a retrospective comparative cohort study.

A diverting loop ileostomy (DLI) is performed in laparoscopic anterior rectal resection (LAR) surgery at high risk of anastomotic fistula. Minimally invasive surgery promotes postoperative recovery and cosmetics. To reduce abdominal trauma, specimen extraction through stoma incision (EXSI) is usually performed to avoid auxiliary abdominal incision with enlarged stomal incision. The traditional suture method (TSM) reduces the incision size by suturing the ends of the enlarged incision, leading to peristomal incisions and a higher risk of stomal complications. The study aimed to introduce the dumpling suture method (DSM) of PLI and compare this new method with TSM. The authors propose a novel stoma suture technique, which utilized a method of skin folding suture to reduce the enlarged incision size. A retrospective analysis was conducted on 71 consecutive patients with rectal cancer who underwent LAR-DLI with EXSI, and the intraoperative details and postoperative outcomes of the two groups were measured. The DSM group showed a lower stomal complication rate (10.3 vs. 35.7%, P=0.016) than that of the TSM group. The scores of DET (Discoloration, Erosion, Tissue overgrowth), stomal pain, quality of life were all significantly lower in DSM group than in TSM group. In multivariate analysis, DSM was an independent protective factor for stoma-related complications. Operative time, time to first flatus, defecation and eat, nonstomal related postoperative complications were similar in both groups. DSM utilizes a method of skin folding suture to reduce the enlarged incision size, which is safe and effective in reducing the incidence of peristomal skin infections and stomal complications. This procedure offers a novel suturing approach for loop ileostomy with enlarged incision, effectively reducing the postoperative trauma and incidence of stomal complications.

Outcomes of anastomosis of mechanically prepared bowel vs. mechanically unprepared bowel in laparoscopic anterior resection in adult patients with rectal cancer

Introduction: The limited literature supporting the utilization of mechanical bowel preparation (MBP) for patients undergoing laparoscopic anterior resection of rectum (LAR) remains a notable issue. This study was conducted to examine the clinical consequences of anastomosis in rectal surgery with MBP compared to cases where MBP is not utilized (no-MBP) in the context of LAR.Methods: This is a retrospective comparative study conducted in the professorial surgical wards of Teaching Hospital Karapitiya (THK). Rectal cancer patients (n=306) participated in the study, including 151 MBP patients and 155 no-MBP patients where the postoperative complications and mortality rates were compared.Results: The anastomotic leakage rate was 2.6% (n=4) in the no-MBP group and 6.0% (n=9) in the MBP group, (p=0.143). Postoperative paralytic ileus rate was 18.5% (n=28) and 5.8% (n=9) in the MBP group and no-MBP group respectively displaying a statistically significant difference (p=0.001). Wound infection, pneumonia, urinary tract infection, and cardiac complication rates also were higher in the MBP group. Overall mortality rate was 1.3% (n=3) in no-MBP group and 2.0% (n=2) in MBP group. Conclusions: The evidence concludes that MBP increases post-operative complications. Therefore, prophylactic MBP in LAR has not been proven to benefit patients. However, further research is necessary to understand the comparative effects of MBP versus no preparation comprehensively.

Late Diagnosis of Urinary Peritonitis Due to a Lesion of the Left Ureter During Laparoscopic Anterior Resection of the Rectum—Laparoscopic Solution. Clinical Case and Literature Review

Late Diagnosis of Urinary Peritonitis Due to a Lesion of the Left Ureter During Laparoscopic Anterior Resection of the Rectum—Laparoscopic Solution. Clinical Case and Literature Review

A 3 mm Port Reduces Postoperative Pain After Laparoscopic Colon Cancer Surgery: A Case-control Matched Study.

Recently, smaller-size trocars and instruments have been developed for laparoscopic colon cancer surgery; however, their effectiveness and safety have not been elucidated. This study aimed to investigate whether 3 mm trocars and instruments have benefits compared with conventional trocars and instruments. Patients with colon cancer who underwent laparoscopic anterior resection or right hemicolectomy were included. Patients who underwent combined resections of other organs and those with conversion to open surgery were excluded. In the 3 mm group, three 5 mm trocars were replaced by 3 mm trocars. The numeric rating scale (NRS) immediately postoperatively at 24, 48, and 72 hours, respectively, after surgery and the use of additional analgesics and perioperative outcomes were analyzed. Case-control matched analysis was used to reduce bias according to the type of surgery. A total of 207 patients (conventional: n = 158, 3 mm: n = 49) were included. Before matching, NRS 48 hours postoperatively ( P = 0.049), proportion of patients using additional intravenous (IV) analgesics ( P = 0.007), postoperative hospital stay ( P < 0.001), and blood loss ( P < 0.001) were lower in the 3 mm group. In multivariable analysis, trocar type significantly impacted the proportion of patients using additional IV analgesics (odds ratio: 0.330; 95% CI: 0.153-0.712; P = 0.005). After case-control matching, NRS immediately postoperatively ( P = 0.015) and 24 hours postsurgery ( P = 0.043), patients using additional IV analgesics ( P = 0.019), postoperative hospital stay ( P = 0.010), intraoperative blood loss ( P < 0.001), and postoperative complication rate ( P = 0.028) were significantly lower in the 3 mm group compared with the 5 mm group. The use of 3 mm trocars and instruments in laparoscopic colon cancer surgery can effectively reduce postoperative pain while maintaining perioperative safety.

Features and outcomes of rectal cancer patients treated in a hospital in Bogotá, Colombia: a retrospective cohort study

Rectal cancer is an increasing disease worldwide. The outcomes of its treatment are related to the preoperative characteristics of the patient. The objective of this study was to describe sociodemographic, clinical and surgical characteristics and outcomes of patients operated on for rectal cancer at Hospital Universitario Mayor Méderi (HUM) during the period within 2013–2017.A retrospective descriptive cohort-type study was carried out by consulting the clinical records of patients above the age of 18 years with a clinical/histopathological diagnosis of rectal cancer and an institutional follow-up in those who underwent surgery with laparoscopic anterior resection of the rectum carried out by the coloproctology service of the HUM between 2013 and 2017. For statistical analysis, the SPSS V22 program was used.Data from 133 patients were collected during the study period, most of them male, with more frequent involvement of the lower rectum. Complications occurred in 25% of the patients. Conversion rate to open surgery was 8.6%, in-hospital death was associated with cardiovascular comorbidity, corticosteroid uses and with the presence of complications. Sociodemographic characteristics of the patients were similar to the world population. The institution has a low prevalence of anastomotic dehiscence, global complications are comparable with international statistics.

113 Does Robotic Anterior Resection Improve the Outcomes for Patients with Rectal Cancer Over Standard Laparoscopic Surgery?

Abstract Background Currently, laparoscopic anterior resection (L-AR) is the standard approach for rectal cancer (RC) treatment. Increasingly, AR procedures have been conducted robotically using the Da Vinci Surgical System (DVSS). Its design has the potential to improve upon the operative outcomes of L-AR. However, the DVSS’s controversial price of $2,000,000 has slowed its clinical adoption. There has been speculation as to whether the clinical outcomes conferred by robotic-assisted AR (R-AR) merits the cost of the DVSS. Aim To review the literature on R-AR and L-AR surgery for RC, primarily comparing the clinical outcomes of each approach, with an auxiliary evaluation of cost-effectiveness. Method A literature search was performed using the databases OVID Embase, MedLine, and Web of Science. The keywords ‘anterior resection’, ‘rectal neoplasm’, ‘robotics’, ‘robotic surgical procedures’, and ‘laparoscopy’ were entered into each database. 141 records were initially retrieved and screened for relevance. The remaining texts that were fully available and adhered to the eligibility criteria were included in this review. Results Ten studies were identified. R-AR resulted in higher quality TME specimens in three studies, (p = 0.02, 0.03, 0.033). and in shorter hospital stays and longer operative times in four studies: (p = 0.03, 0.0001&amp;lt;, 0.001&amp;lt;, 0.001). Overall, R-AR had lower rates of intraoperative complications. Conclusions Generally, R-AR seemed to deliver better outcomes, but there is insufficient evidence to establish its superiority over L-AR. Longitudinal studies with extended research periods are required to evaluate the long-term oncological benefits of R-AR.

205 Single-Centre Review on Incisional Hernia After Laparoscopic Anterior Resection: What Is the Ideal Incision for Specimen Extraction?

Abstract Aim Midline incision was reported as the common site of incisional hernia (IH) after hand-assisted laparoscopic anterior resection (LAR). There is no consensus on the ideal site for specimen extraction. Our aim was to compare the rate of IH at various specimen extraction sites at our institution. Method We retrospectively reviewed data of 90 cases of LAR from May 2015 to February 2018. Patients were divided into three groups such as Pfannenstiel, iliac fossa (ILF) and midline. Age, sex, BMI, diabetes, steroid use, smoking, wound infection, hernia, post-operative hospital stays (HS) and length of follow up (LOF) were compared among these groups. Results There were 13, 44 &amp; 33 patients in Pfannenstiel, ILF and midline groups. There was no significant difference in age, gender, BMI, smoking, steroid use, and mean LOF among groups. Patients in the ILF group had the highest prevalence of diabetes (27%), mean BMI of 28.91, rate of wound infection (16%), and incidence of incisional hernia (16%). The midline group had the highest mean age of 72.45 years and the longest HS of 11.45 days (p &amp;lt; 0.003). At 49-month follow up, none of the Pfannenstiel group developed wound infection or IH (0%). However, there was no strong association between hernia and type of incision (p 0.248). Conclusions Although Pfannenstiel incision was found to have the lowest rate of IH, the analysis was not significant due to the small sample. We suggest future studies to have larger samples with proper randomization to propose that Pfannenstiel is the ideal incision for specimen extraction.

ThTP4.1 Evaluation of Post-operative Outcomes in Laparoscopic &amp; Open Anterior Resections (AR) for Rectal Cancer: A 15 year cohort study

Abstract Aims AR offers sphincter preserving surgery for rectal cancers, &amp; has functionally comparable results to APER's or Hartmann’s resection. Use of mechanical stapling devices has allowed laparoscopic AR to become widely available. Aim of study is to evaluate post-operative outcomes in laparoscopic AR’s. Methods A cohort study collated post-operative outcomes in laparoscopic AR’s performed at a single-centre from January 2008 to February 2023. Open AR’s were recruited as controls. Results Conclusion Laparoscopic AR accounted for prolonged operative times &amp; shorter hospital stay. There were no differences in early post operative mortality &amp; complications. Laparoscopic AR had better long term survival, This could be explained by better case selection for laparoscopic AR (since laparoscopic resection were adopted as routine practise, as opposed to open AR became less employed in recent years).