Simple instruments facilitating achievement of transanal total mesorectal excision in male patients

Table 1 Clinical characteristics of male patients with low rectal cancer n (%)

Variable	Group A, n = 41	Group B, n = 74	P value
Age in yr1	62.4 ± 11.2	59.0 ± 12.6	0.630
ASA score			0.787
1	6 (14.6)	8 (10.8)
2	24 (58.5)	43 (58.1)
3	11 (26.8)	23 (31.1)
BMI1	24.8 ± 2.3	25.0 ± 2.8	0.193
Intertuberous diameter in mm2	98 (83-110)	99 (86-111)	0.426
Distance of tumors from the anal verge in mm2	4 (0.5-5)	4 (1-5)	0.160
Tumor diameter in mm2	50 (40-70)	50 (40-70)	0.679
Laparoscopy for abdominal operation	17 (41.5)	43 (58.1)	0.087
Ostomy	18 (43.9)	72 (97.3)	0.000
Operators			0.815
A	26 (63.4)	51 (68.9)
B	9 (22.0)	13 (17.6)
C	6 (14.6)	10 (13.5)
Neoadjuvant radiotherapy	3 (12.5)	16 (35.6)	0.041
Adjuvant radiotherapy	2 (7.7)	4 (11.8)	0.602
Adjuvant chemotherapy	16 (55.2)	32 (64.0)	0.439
pT			0.458
pT1	2 (4.9)	4 (5.4)
pT2	12 (29.3)	30 (40.5)
pT3	27 (65.9)	40 (54.1)
TNM stage			0.189
Stage I	12 (29.3)	28 (37.8)
Stage II	13 (31.7)	29 (39.2)
Stage III	16 (39.0)	17 (23.0)

¹Values are mean ± SD;

²Values are median (range). Group A: A classical approach; Group B: A modified approach with retrograde transanal total mesorectal excision. BMI: Body mass index; TNM: Tumor node metastasis.

Table 2 Clinicopathological outcomes n (%)

Variable	Group A, n = 41	Group B, n = 74	P value
Total operating time in min2	280 (200-360)	240 (160-330)	0.000
Blood loss in mL2	80 (20-500)	60 (20-300)	0.184
Hospital stays after operation2	8 (7-23)	8 (6-19)	0.341
Distance of tumors from distal margin in mm1	16.9 ± 5.3	17.9 ± 4.9	0.466
Distal mesorectum			0.000
Complete	31 (75.6)	74 (100)
Nearly complete	7 (17.1)	0 (0)
Incomplete	3 (7.3)	0 (0)
Total mesorectum			0.008
Complete	29 (70.7)	67 (90.5)
Nearly complete	9 (22.0)	7 (9.5)
Incomplete	3 (7.3)	0
Distal involvement			1.000
Positive	0 (0)	0 (0)
Negative	41 (100)	74 (100)
Circumferential resection margin			0.543
Positive	2 (4.9)	2 (2.7)
Negative	39 (95.1)	72 (97.3)

¹Values are mean ± SD;

²Values are median (range). Group A: A classical approach; Group B: A modified approach with transanal total mesorectal excision.

Table 3 Postoperative complications in male patients with low rectal cancer n (%)

Variable	Group A, n = 41	Group B, n = 74	P value
Anastomotic leakage	2 (4.9)	2 (2.7)	0.542
Anastomotic stricture	6 (14.6)	12 (16.2)	0.823
Postoperative inflammatory intestinal obstruction	2 (4.9)	4 (5.4)	0.903
Urinary tract infection	1 (2.4)	4 (5.4)	0.455
Wound infection	3 (7.3)	4 (5.4)	0.681
Urinary retention	3 (7.3)	5 (6.8)	0.91
Clavien-Dindo classification			0.85
I	5 (12.2)	7 (9.5)
II	3 (7.3)	10 (13.5)
III	2 (4.9)	0

Data are presented as n (%). Group A: A classic approach; Group B: A modified approach with retrograde transanal total mesorectal excision.

Table 4 Postoperative anal functional results of male patients with low rectal cancer n (%)

Items	Pre-operation			1 yr after operation
	Group A	Group B	P value	Group A	Group B	P value
MRP in kPa	12.2 ± 2.2	13.1 ± 3.5	0.126	8.8 ± 2.3	9.0 ± 2.8	0.087
MSP in kPa	18.0 ± 3.6	17.3 ± 3.0	0.054	16.3 ± 3.3	17.6 ± 2.8	0.201
HZL in mm	32.2 ± 5.1	34.7 ± 5.5	0.7	24.9 ± 4.5	24.2 ± 5.9	0.080
Wexner score	0.4 ± 1.2	0.2 ± 0.8	0.112	2.7 ± 2.7	3.6 ± 3.8	0.099
Kirwan classification			0.591			0.617
I	34 (82.9)	64 (86.5)		15 (36.6)	22 (29.7)
II	7 (17.1)	9 (12.2)		16 (39.0)	25 (33.8)
III	0	1 (1.4)		7 (17.1)	19 (25.7)
IV	0	0		3 (7.3)	8 (10.8)
V	0	0		0	0

Wexner scores are presented as number (SD): 0 = perfect continence; 20 = major incontinence. Kirwan classifications are presented as number: Grade I = perfect; Grade II = incontinence of flatus; Grade III = occasional minor soiling; Grade IV = frequent major soiling; Grade V = incontinence. HZL: High-pressure zone length; MRP: Maximum resting pressure; MSP: Maximum squeeze pressure.