Analysis of bacterial culture of fluid in the surgical area in transanal total mesorectal excision and laparoscopic total mesorectal excision

Abstract

Abstract Purpose To investigate the clinical value of the bacterial culture of fluid in the surgical area in laparoscopic transanal total mesorectal excision (Lap-taTME) and laparoscopic total mesorectal excision (Lap-TME). Methods Clinical data of 106 patients who had successfully undergone radical resection of rectal cancer at gastrointestinal surgery department of the First Affiliated Hospital of Chongqing Medical University from September 2017 to August 2019 were retrospectively collected. There were 56 patients in the Lap-taTME group and 50 patients in the Lap-TME group. In the Lap-taTME group, the initial pelvic fluid, the rectal cavity fluid after purse-string suture, and the pelvic cavity fluid after anastomosis were collected and recorded as culture No.1, No.2, and No.3, respectively. In the Lap-TME group, culture No.1 and No.3 were collected as done in the Lap-taTME group. The postoperative pathology, culture results, and postoperative complications were statistically analyzed. Results The postoperative pathological results showed that the positive rates of distal margin, proximal margin, and circumferential resection margin were zero in both groups, and there were no significant intergroup differences in the total number of lymph nodes detected and pathological TNM stage (all P > 0.05). The positive rate of culture No.1 was zero in both groups, and there were six cases (10.7%) with positive culture No.2 in the Lap-taTME group. However, the number of patients with positive culture No.3 in the Lap-taTME group (7, 12.5%) was significantly higher than that in the Lap-TME group (0) (P < 0.05), and the number of cumulative positive culture cases in the Lap-taTME group (11, 19.6%) was significantly higher than that in the Lap-TME group (0) (P < 0.05). Pelvic infection occurred in four (7.1% of all cases) of the eleven cases with positive culture (19.6% of all cases) in the Lap-taTME group, accounting for 36.4% of the cases with positive culture (4/11). There were no significant intergroup differences in anastomotic leakage and pelvic infection (all P > 0.05). Conclusions Positive bacterial culture of fluid during Lap-taTME indicates an increased risk of pelvic infection after operation. Lap-taTME is more prone to intraoperative contamination than Lap-TME but does not significantly increase the risk of postoperative pelvic infection.