A Prolonged Operative Time Nullifies the Postoperative Advantages of Laparoscopic Rectal Resection (14th World Congress of Endoscopic Surgery and 22nd International Congress of the European Association for Endoscopic Surgery (EAES) Paris, France, 25–28 June 2014)

Aims: Laparoscopic rectal resection is associated with short-term advantages compared to open surgery. The effects of prolonged operative time on those benefits are yet to be defined. Methods: A prospective Enhanced Recovery Program database (2006–2013) was retrospectively analyzed. Anterior rectal resections for cancer or benign condition were included. The outcomes of laparoscopic rectal resections requiring more than 4 hours (4HRS) were compared to those of laparoscopic rectal resections requiring less than 4 hours (LAP) and of OPEN cases. The exclusion criteria included multivisceral resections, reoperations, and laparoscopic cases requiring conversion to open surgery. Fisher’s exact, chisquared or Wilcoxon Rank Sum tests were used as appropriate. P value\0.05 was considered significant. Results: Data were available for 35 4HRS, 53 LAP and 90 OPEN patients. No differences were observed in median age, ASA score and primary disease among the groups. LAP group had a decreased rate of low anterior resections compared to 4HRS (7.6 vs 22.9 %, p 0.04). The median operative time in 4HRS group (282 min) was significantly higher than LAP (190 min, p\0.001) and OPEN (154 min, p\0.001) groups. No major intraoperative complications were recorded. The 4HRS required a higher ileostomy rate than LAP patients (65.7 vs 13.2 %, p\0.001), and a median postoperative length of stay of 10 days, comparable to that of OPEN patients (11 days, p 0.3), but significantly longer than that of LAP cases (6 days, p 0.04). Earlier mobilisation was possible in LAP compared to 4HRS patients (2 vs 3 days, p 0.01), while flatus and first bowel movement time was comparable among the groups. The overall surgical complication rate in 4HRS group (42.9 %) was comparable to OPEN (45.6 %, p0.8) but significantly higher than LAP patients (15.1 %, p 0.003). The incidence of ileus (28.6 vs 13.2 %, p 0.05), anastomotic leak (8.6 vs 0 %, p 0.03) and intrabdominal collection (11.4 vs 0 %, p 0.01) were significantly higher in 4HRS than in LAP group. Conclusions: Increased operative time of laparoscopic anterior resection is associated with significantly worse postoperative outcomes. Preemptive conversion to open surgery is advisable when a prolonged operative time is expected.