Analysis of factors influencing the technical difficulty of laparoscopic conformal sphincter-preserving surgery for low rectal cancer based on anatomical foundations

doi:10.3877/cma.j.issn.1674-0793.2026.05.002

Abstract

Abstract:

Objective

To explore the factors influencing the technical difficulty of laparoscopic conformal sphincter-preservation operation (CSPO) for low rectal cancer (LRC) based on anatomical foundations.

Methods

A case-control study was conducted. Data from 60 patients were analyzed with LRC who underwent laparoscopic CSPO for LRC in the Joint Logistics Support Force 980th Hospital from January 2022 to January 2025 following neoadjuvant therapy. The cases were grouped according to the difficulty of the surgery, with 26 cases in the high-difficulty surgery group and 34 cases in the normal surgery group. The differences in general information, anatomical indicators, pathological data, and post-chemotherapy indicators between the two groups were compared.

Results

Compared to the normal surgery group, the high-difficulty surgery group exhibited shorter distance from the lower edge of the tumor to the anal margin (t=-2.354, P<0.05), longer maximum tumor diameter (t=2.544, P<0.05), shorter circumferential margin distance (t=-6.568, P<0.001), and smaller ischial tuberosity diameter (t=-2.232, P<0.05).

Conclusions

The distance from the lower edge of the tumor to the anal margin, the maximum tumor diameter, the circumambulatial margin distance, and the diameter of the ischial tuberosity are the key factors affecting the technical difficulty of laparoscopic CSPO for LRC after neoadjuvant therapy. Accurate preoperative assessment of these anatomical and oncological indicators can help to optimize surgical planning and improve the safety and effectiveness of anus-preserving surgery.

Key words: Rectal neoplasms, Anatomy, Laparoscopy, Conformal sphincter-preservation operation, Low rectal cancer

Jinbao Yang, Wei Li, Bing Zhang, Jian Chen, Jizhe Wang, Yujia Wang, Shun Wang, Zhibin Jiang, Jianling Yang. Analysis of factors influencing the technical difficulty of laparoscopic conformal sphincter-preserving surgery for low rectal cancer based on anatomical foundations[J]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(05): 297-301.

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Figures/Tables 4

References 21

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组别	例数	年龄(岁)^a	性别		体重指数(kg/m²)^a	肠道清洁度(分)^a
组别	例数	年龄(岁)^a	男	女	体重指数(kg/m²)^a	肠道清洁度(分)^a
高难度手术组	26	57.89±11.78	10	16	23.17±2.04	8.67±0.58
正常手术组	34	56.63±12.35	14	20	23.62±1.93	8.75±0.56
统计值		0.363	0.045		-0.873	-0.491
P值		0.718	0.832		0.386	0.626
组别	既往腹部手术史	基础疾病		血红蛋白(g/L)^a	白蛋白(g/L)^a	术前血小板计数(×10⁹/L)^a
组别	既往腹部手术史	高血压、糖尿病	无	血红蛋白(g/L)^a	白蛋白(g/L)^a	术前血小板计数(×10⁹/L)^a
高难度手术组	7	7	19	120.46±18.95	42.05±6.94	185.62±32.47
正常手术组	9	11	23	123.63±20.14	40.51±7.23	192.35±35.18
统计值	0.002	0.207		-0.563	0.756	-0.759
P值	0.963	0.649		0.576	0.453	0.451

组别	例数	年龄(岁)^a	性别		体重指数(kg/m²)^a	肠道清洁度(分)^a
组别	例数	年龄(岁)^a	男	女	体重指数(kg/m²)^a	肠道清洁度(分)^a
高难度手术组	26	57.89±11.78	10	16	23.17±2.04	8.67±0.58
正常手术组	34	56.63±12.35	14	20	23.62±1.93	8.75±0.56
统计值		0.363	0.045		-0.873	-0.491
P值		0.718	0.832		0.386	0.626
组别	既往腹部手术史	基础疾病		血红蛋白(g/L)^a	白蛋白(g/L)^a	术前血小板计数(×10⁹/L)^a
组别	既往腹部手术史	高血压、糖尿病	无	血红蛋白(g/L)^a	白蛋白(g/L)^a	术前血小板计数(×10⁹/L)^a
高难度手术组	7	7	19	120.46±18.95	42.05±6.94	185.62±32.47
正常手术组	9	11	23	123.63±20.14	40.51±7.23	192.35±35.18
统计值	0.002	0.207		-0.563	0.756	-0.759
P值	0.963	0.649		0.576	0.453	0.451

组别	例数	肿瘤下缘至肛缘距离(cm)^a	肿瘤位置			肿瘤最大径(cm)^a	肿瘤浸润深度cT		淋巴结转移cN
组别	例数	肿瘤下缘至肛缘距离(cm)^a	前壁	后壁	侧壁	肿瘤最大径(cm)^a	2	3	0	1	2
高难度手术组	26	3.53±0.68	8	11	7	4.51±1.21	10	16	8	11	7
正常手术组	34	4.05±0.83	10	13	11	3.49±1.52	19	15	16	10	8
统计值		-2.354	0.215			2.544	1.791		1.745
P值		0.023^b	0.899			0.014^b	0.181		0.418

组别	例数	肿瘤下缘至肛缘距离(cm)^a	肿瘤位置			肿瘤最大径(cm)^a	肿瘤浸润深度cT		淋巴结转移cN
组别	例数	肿瘤下缘至肛缘距离(cm)^a	前壁	后壁	侧壁	肿瘤最大径(cm)^a	2	3	0	1	2
高难度手术组	26	3.53±0.68	8	11	7	4.51±1.21	10	16	8	11	7
正常手术组	34	4.05±0.83	10	13	11	3.49±1.52	19	15	16	10	8
统计值		-2.354	0.215			2.544	1.791		1.745
P值		0.023^b	0.899			0.014^b	0.181		0.418

组别	例数	肿瘤退缩分级					环周切缘距离(mm)^a	直肠系膜纤维化分级			C反应蛋白(mg/L)^a	白细胞介素-6(ng/L)^a
组别	例数	1	2	3	4	5	环周切缘距离(mm)^a	1	2	3	C反应蛋白(mg/L)^a	白细胞介素-6(ng/L)^a
高难度手术组	26	4	6	7	5	4	1.79±0.64	6	15	5	17.35±7.60	23.16±9.35
正常手术组	34	13	16	3	2	0	3.58±1.27	14	18	2	15.79±6.83	22.61±9.64
统计值		2.956					-6.568	3.757			0.835	0.222
P值		0.565					<0.001^b	0.152			0.407	0.825

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