Are the criteria of the international consensus relevant for laparoscopic left hemicolectomy with transanal specimen extraction?

AIM: to optimize patient selection criteria for the laparoscopic left hemicolectomy with transanal specimen extraction (TES).

PATIENTS AND METHODS: the treatment outcomes of 68 patients who underwent surgery for left-sided colon tumours between October 2022 and August 2024 were analyzed. Transanal extraction of the specimen (TES) was successfully performed in 42 (62%) cases (TES group), while 26 (38%) patients required a minilaparotomy (minilaparatomy group — ML). In addition to assessing early postoperative outcomes, intraoperative specimen circumference was measured in all patients, and the sensitivity and specificity of the patient selection criteria according to the Consensus were analyzed.

RESULTS: in the successful TES group, in addition to the excellent cosmetic effect due to the absence of an incision in the anterior abdominal wall, several advantages were also identified, such as a pain reduction already within the first day of the postoperative period — 3 (2; 4.3) points in the TES group compared to 5 (4; 6) points in the ML group (p < 0.001) with a significant decrease in the complication rate: 3/42 (7%) cases in the TES group versus 8/26 (31%) in the ML group (p = 0.0003). The circumference of the specimen in the TES group was 11.7 (2.6) cm, while in the ML group it was 16.2 (2.1) cm (p < 0.0001). The threshold value of this parameter for successful TES, based on ROC-analysis, was 16 cm. The diagnostic value of the Consensus criteria in predicting the successful performance of TES showed that their relative risk (RR) was 2.3 (95% CI: 1.2–5.1); p = 0.004; sensitivity — 88.1% (95% CI: 75-94.8); specificity — 42.3% (95% CI: 25.5-61.1). Adding another parameter (intraoperative circumference of the specimen) to the Consensus criteria significantly increased the diagnostic value: RR = 3.1 (95% CI: 1.8–6.2); p < 0.0001; sensitivity = 83.3% (95% CI: 69.4-91.7); specificity = 73.1% (95% CI: 53.9-86.3).

CONCLUSION: laparoscopic left hemicolectomy with transanal specimen extraction demonstrates superior early postoperative outcomes compared to laparoscopy-assisted procedures with minilaparotomy. Adding intraoperative specimen circumference to the Consensus criteria for TES patient selection significantly improves their accuracy.

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