Impact of Procedure Time of Preceding Endoscopic Submucosal Dissection on the Difficulty of Laparoscopic Rectal Surgery

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.