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Session: ePoster: Education, Training Assessment, and Practice Management 1 (Sun8)

EP289 - What 21 years of Rectal Surgery can show us from a low-to-middle-income country experience after implementing minimally invasive surgery

Sunday, May 11, 2025

9:49 AM – 9:54 AM PT

Location: Monitor 5, Sails Pavilion, Upper Level

ePoster Presenter(s)

Sarah Benammi, MD

Attending physician
MOHAMED VI UNIVERSITY OF SCIENCES AND HEALTH
Casablanca, Grand Casablanca, Morocco

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

YB

Youness Bakali, MD

Professor
UNIVERSITY MOHAMED V
Rabat, Rabat-Sale-Zemmour-Zaer, Morocco

Disclosure information not submitted.
MA

Mouna Alaoui, MD

Professor
UNIVERSITY MOHAMED V
rabat, Rabat-Sale-Zemmour-Zaer, Morocco

Disclosure information not submitted.
FS

Farid Sabbah, MD

Professor
UNIVERSITY MOHAMED V
rabat, Rabat-Sale-Zemmour-Zaer, Morocco

Disclosure information not submitted.
MR

Mohamed Raiss, MD

Professor
UNIVERSITY MOHAMED V
rabat, Rabat-Sale-Zemmour-Zaer, Morocco

Disclosure information not submitted.

Senior Author(s)

AH

Abdelmalek Hrora, MD

Professor
UNIVERSITY MOHAMED V
Rabat, Rabat-Sale-Zemmour-Zaer, Morocco

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Sarah Benammi, MD: This individual has no financial relationships with ineligible companies.

Abdelmalek Hrora, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: The objective of our study was to assess minimally invasive rectal surgery implementation in our center and analyze anastomotic fistula after rectal cancer surgery.

Methods/Interventions: This was a retrospective study conducted in a developing country university hospital from 2001 to 2022. All patients admitted for treatment of rectal cancer were included. We excluded non-cancer cases and palliative interventions.

Results/Outcomes: From 891 hospitalizations for rectal surgery, we included a total of 306 patients. Minimally invasive cases were 39.9% vs 60.1% for open surgery over the entire study period. The first minimally invasive surgery was reported in 2005. By 2014 minimally invasive cases were more frequent than open surgery. Laparoscopy was used more for low rectal cancer (73=n), followed by mid-rectum (28=n), and upper rectum (15=n). Anastomotic fistulas were reported in 16.3% (45=n) of all included cases, 71.1% of them were in open cases vs 28.9% in minimally invasive cases. In univariate analysis, the covariates associated with anastomotic fistulas were the location of the rectal tumor (p = 0.016), the neoadjuvant treatment reported (p = 0.030), the surgical resection R0vsR1 (p = 0.007) and the creation of the diverting stoma (p = 0.006). On multivariate analysis, neoadjuvant treatment and surgical resection R0vsR1 were significantly associated with anastomotic fistulas (p = 0.009) and (p = 0.006) respectively.

Conclusion/Discussion: Anastomotic fistula is the most detrimental postoperative complication among all factors reported in terms of impact on morbidity, mortality and quality of life. Such nuisances in the oncological and functional prognosis underline the need to elucidate the question of the risk factors involved in the occurrence of anastomotic fistulas. Our study emphasises on the advantages of minimally invasive surgery and the possibility of implementing change without negatively impacting the surgical outcome.