eP355 - Long-term Oncologic Outcomes Between Ambidextrous and Right-handed Surgeons in Laparoscopic Surgery for Low Rectal Cancer: A Subgroup Analysis of ASPIRE

ePoster Presenter(s)

• 

  Mi Jeong Choi

  Clinical fellow
  Seoul National University Bundang Hospital
  Seongnam, Kyonggi-do, Republic of Korea

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

Senior Author(s)

• SK

  Sung-Bum Kang, n/a

  Professor
  Seoul National University Bundang Hospital
  Seongnam, Kyonggi-do, Republic of Korea

  Disclosure information not submitted.

Author(s)

• HA

  Hong-min Ahn, n/a

  Clinical assistant professor
  Seoul National University Bundang Hospital
  Seongnam, Kyonggi-do, Republic of Korea

  Disclosure information not submitted.
• HS

  Hye Rim Shin, n/a

  Clinical fellow
  Seoul National University Bundang Hospital
  Seongnam, Kyonggi-do, Republic of Korea

  Disclosure information not submitted.
• 

  Tae Gyun Lee, MD

  Clinical Assistant Professor
  Ajou University Hospital / Seoul National University Bundang Hospital
  Seoul National University
  Suwon, Kyonggi-do, Republic of Korea

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

  Min Hyeong Jo

  Clinical fellow
  Seoul National University Bundang Hospital
  Seongnam, Kyonggi-do, Republic of Korea

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

  Duck-Woo Kim, n/a

  Professor
  Seoul National University Bundang Hospital
  Seongnam, Kyonggi-do, Republic of Korea

  Disclosure information not submitted.
• HO

  Heung-Kwon Oh, n/a

  Professor
  Seoul National University Bundang Hospital
  Seongnam, Kyonggi-do, Republic of Korea

  Disclosure information not submitted.

Purpose/Background: Less than 10% of the surgical population is ambidextrous. To avoid discomfort from universal port placement, which is based on right-handed surgeon, ambidextrous surgeon may place trocars at different sites for laparoscopic surgeries. This study compared the oncologic outcomes between ambidextrous and right-handed surgeons in laparoscopic rectal cancer surgery in a subgroup of a long-term prospective multicenter cohort (ASPIRE study).Methods/Interventions: Patients aged 20–80 years with low rectal adenocarcinoma and an inferior margin ≤ 5 cm from the anal verge who underwent laparoscopic surgery between December 2011 and August 2016 were analyzed in a subgroup of ASPIRE long-term prospective, multicenter cohort study. The cohort was divided into two groups of ambidextrous and right-handed surgeon according to the handedness. Different port placements were performed by ambidextrous surgeon (operator’s left hand at umbilicus, operator’s right hand at right lower quadrant, assistant’s left hand at left lower quadrant, assistant’s right hand at anterior axillary line, and camera port at upper midline). The probabilities of disease-free survival (DFS) were estimated using the Kaplan-Meier technique and compared using log-rank tests. Cox proportional hazards regression was used to identify whether the handedness of the surgeon was associated with 5-year DFS.Results/Outcomes: Laparoscopic rectal cancer surgery was performed on 237 patients: 123 (51.9%) were performed by ambidextrous- and 114 (48.1%) were performed by right-handed surgeons. There was no difference in patient age (60.2±12.0 vs. 59.7±10.4; p = 0.506) and sex (male: 83/123 [67.5%] vs. 77/114 [67.5%]; p = 0.992) between the two groups. Tumor size, pathological T stage, and N stage did not differ between the groups (p = 0.358, p = 0.679, and p = 0.725, respectively). The circumferential resection margin positivity rate was similar in both groups (3.3% vs. 7.0%; p = 0.186). Over a median follow-up period of 73.4 months (48.5-93.9), the 5-year DFS rate was higher in the ambidextrous surgeon than that in the right-handed surgeon group (84.1% vs. 72.8%, p = 0.046). After adjustment, old age (hazard ratio [HR], 1.835; 95% confidence interval [CI], 1,059-3.180; p = 0.030), male sex (HR, 2.346; 95% CI, 1.169-4.710; p = 0.016), and higher pathologic T stage (HR, 2.002; 95% CI, 1.040-3.851; p = 0.038) were considered risk factors for 5-year DFS, but there was no significant difference in 5-year DFS rates for ambidextrous- or right-handed surgeons (HR 1.699; 95% CI, 0.941-2.960; p = 0.080).Conclusion/

Discussion: The subgroup analysis from the ASPIRE study of laparoscopic rectal cancer surgery showed that oncologic survival did not differ between ambidextrous- and right-handed surgeons. Therefore, regardless of handedness, surgeons can flexibly adopt different laparoscopic trocar placement and operative procedures when performing laparoscopic cancer surgery.Different port placements were performed by the ambidextrous surgeons