Abstract:
Objective To explore the influencing factors of technical difficulty in laparoscopic conformal sphincter-preserving operation (CSPO) for low rectal cancer.
Methods A retrospective cohort study was conducted. A total of 62 patients with low rectal cancer who underwent laparoscopic CSPO between January 2022 and June 2025 were enrolled. Clinical data and intraoperative parameters of all patients were collected. Operative duration and intraoperative blood loss were adopted as quantitative indicators of technical difficulty. Univariate analysis and multivariate linear regression models were used to screen independent influencing factors. Statistical analyses were performed using SPSS 26.0 software. Measurement data conforming to normal distribution were expressed as mean (
±
s) standard deviation; non-normally distributed measurement data were presented as median (interquartile range); enumeration data were described as [cases (%)]. Intergroup comparisons were carried out by independent samples
t test,
Mann-Whitney U test and
chi-square test. A
P value less than 0.05 was considered statistically significant.
Results The operative duration of all patients ranged from 100 to 280 minutes, with a median of 185 minutes; intraoperative blood loss varied from 20 to 350 ml, with a median of 85 ml. When operative duration was used to reflect surgical difficulty: tumor distance from the anal verge, clinical TNM (cTNM) stage, history of neoadjuvant chemoradiotherapy, and pelvic stenosis index were all correlated with operative duration (all P<0.05). Multivariate linear regression analysis demonstrated that tumor distance from the anal verge, pelvic stenosis index and cTNM stage were closely associated with operative duration (all P<0.05). When intraoperative blood loss was used to evaluate surgical difficulty: body mass index (BMI), tumor distance from the anal verge, cTNM stage and pelvic stenosis index were all correlated with intraoperative blood loss (all P<0.05). Multivariate linear regression further verified that tumor distance from the anal verge, pelvic stenosis index and cTNM stage were independent factors closely related to intraoperative blood loss.
Conclusion The technical difficulty of laparoscopic CSPO is jointly affected by anatomical and pathological factors. Tumor distance from the anal verge, pelvic stenosis index and cTNM stage are strongly correlated with operative duration and intraoperative blood loss, and can serve as core indicators for the preoperative assessment of surgical difficulty.
Key words:
Low Rectal Tumors,
Laparoscopes,
Conformal Sphincter-Preservation Operation,
Surgical Difficulty,
Influencing Factors
Jinbao Yang, Wei Li, Bing Zhang, Jian Chen, Jizhe Wang, Yujia Wang, Shun Wang, Zhibin Jiang, Ye Zhou, Jianling Yang. Analysis of influencing factors for technical difficulty of laparoscopic conformal sphincter-preserving surgery for low rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(04): 343-346.