Predicting Difficult Laparoscopic Total Mesorectal Excision for Locally-advanced Mid-low Rectal Cancer: The

The European MRI and Rectal Cancer Surgery (EuMaRCS) score was proposed to identify preoperatively difficult laparoscopic total mesorectal excision (L-TME) for locally advanced rectal cancer (LARC). This study aimed to test EuMaRCS's validity.Data were retrieved from a European multicenter database, including patients with mid/low LARC, treated with neoadjuvant chemoradiation therapy and L-TME with primary anastomosis. The EuMaRCS score was calculated on: BMI30 (3 points), interspinous distance96.4 mm (2 points), ymrT stage≥T3b (4 points), and male sex (1 point).The sample was composed of 141 patients, of whom 23 (16.3%) had a difficult L-TME. The EuMaRCS score demonstrated high accuracy in predicting difficult surgery (AROC: 0.806, 95%CI=0.72-0.88), with a cut-off3 being associated with the best balance in sensitivity (82.6%) and specificity (66.1%).The EuMaRCS score represents a validated tool to predict preoperatively difficult L-TME in LARC patients.