Purpose: This study aimed to identify the risk factors associated with performing a difficult laparoscopic radical resection of rectal cancer, and to establish a predictive nomogram to help individual clinical treatment decisions.
Methods: A total of 977 patients with rectal cancer who underwent laparoscopic radical resection between January 2014 and December 2016 were enrolled in this study. The difficulty of laparoscopic-assisted rectal resection (LARR) was defined according to the scoring criteria reported by Escal. A logistic regression analysis was performed to identify the variables that may affect the difficulty of LARR, and a nomogram predicting the surgical difficulty was created.
Results: A multivariate analysis demonstrated that a BMI > 28 kg/m2, the distance between the tumor and the anal margin ≤ 5 cm, the maximum transverse tumor diameter > 3 cm tumor, interspinous distance < 10 cm, history of abdominal surgery, and preoperative radiotherapy were independent risk factors and they were, therefore, included in the predictive nomogram for identifying a difficult LARR.
Conclusions: This study defined a difficult LARR and identified independent risk factors for a difficult operation and created a predictive nomogram for difficult LARR. This nomogram may facilitate the stratification of patients at risk for being associated with a difficult LARR for rectal cancer.
Keywords: Decision curve; Difficult operation; Nomogram model; Rectal cancer.
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