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Figure legends

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Figure 1. Pelvic inlet measurements. a) Obstetric conjugate. b) Transverse diameter.

282

283

Figure 2. Simple linear regression analyses performed to assess the association between TME time and

284

clinical factors. *P<0.05

285

BMI body mass index, Lap-LAR laparoscopic low anterior resection, TaTME transanal TME, TME total

286

mesorectal excision, TME time time required for TME

287

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Figure 3. Comparison of TME time between male patients and female patients.

289

Lap-LAR laparoscopic low anterior resection, TaTME transanal TME, TME time time required for TME

Table 1. Patients and tumor characteristics

Lap-LAR (n=52)

TaTME (n=35)

Age, median (range)

68

(40-96)

64

(34-85)

0.668

Female sex, n (%)

18

(34.6)

11

(31.4)

0.757

BMI (kg/m2), median (range)

22

(13-41.8)

23

(17.5-32.8)

0.333

Bony pelvic inlet measurements

Obstetric conjugate (mm), median (range)

118.6

(87.6-152.4)

114.3

(90.2-134.8)

0.317

Transverse diameter (mm), median (range)

118.6

(95.0-139.7)

119.5

(108.9-139.6)

0.522

Treatment before surgery

No, n (%)

<0.001

48

(92.3)

17

(48.6)

Chemoradiotherapy, n (%)

(7.7)

12

(34.3)

Chemotherapy, n (%)

(0)

(17.1)

25

(0-72)

The longest diameter of tumor (mm), median (range)

35

(0-95)

cT, n (%)a

0.085

0.037

0/is/1

12

(23.1)

(17.1)

10

(19.2)

10

(28.6)

19

(36.5)

18

(51.4)

11

(21.2)

(2.9)

cN, n (%)a

0.155

28

(53.8)

22

(62.9)

18

(34.6)

(17.1)

(11.5)

(20.0)

cM, n (%)a

0.359

50

(96.2)

32

(91.4)

(3.8)

(8.6)

BMI body mass index, Lap-LAR laparoscopic low anterior resection, TaTME transanal total mesorectal excision

Tumors were classified according to the eighth edition of the Union for International Cancer Control tumor-node-metastasis

cancer staging system.

Table 2. Operative outcomes, postoperative complications, and pathological findings

Lap-LAR (n=52)

TaTME (n=35)

Additional operative procedure

Lateral pelvic lymph node dissection, n (%)

(5.8)

11

(31.4)

0.001

Mobilization of splenic flexure, n (%)

(9.6)

(25.7)

0.047

16

(30.8)

33

(94.3)

<0.001

Construction of diverting ileostomy, n (%)

Conversion to open surgery, n (%)

(0)

(0)

Total operation time (min), median (range)

307

(207-803)

283

(179-531)

0.101

TME time (min), median (range)

197

(111-392)

121

(83-177)

<0.001

(0-175)

0.046

Estimated blood loos, g (range)

(0-300)

Transfusion, n (%)

Yes

(0)

(0)

No

52

(100)

35

(100)

Anastomotic leakage

(7.7)

(6.0)

0.718

Bowel obstruction

(0)

(23.0)

<0.001

Urinary dysfunction

(1.9)

(0)

0.309

17

(8-49)

19

(11-47)

0.129

Postoperative complications, Clavient-dindo

classification grade≧Ⅱ, n(%)

Hospital days, median (range)

Proximal resection margin positive, n (%)

(0)

(0)

Distal resection margin positive, n (%)

(0)

(0)

Circumferential resection margin positive, n (%)

(3.8)

(0)

0.148

Lap-LAR laparoscopic low anterior resection, TME total mesorectal excision, TaTME transanal TME

Table 3. Bony pelvic size and BMI of patients treated by Lap-LAR or TaTME

Lap-LAR

Female(n=18)

Male (n=34)

TaTME

Female (n=11)

Male (n=24)

Obstetric conjugate (mm), median (range)

124.8

(106.7-152.0)

112.3

(87.6-136.3)

0.001

118.8

(105.5-130.5)

113.9

(90.2-134.8)

0.155

Transverse diameter (mm), median (range)

125.2

(108.5-139.7)

115.2

(95.0-131.3)

<0.001

129.6

(111.8-139.6)

117.5

(108.9-128.6)

0.002

22.7

(17.6-41.8)

0.005

21.2

(19.7-32.8)

0.014

BMI (kg/m2), median (range)

20.3

(13.0-29.9)

BMI body mass index, Lap-LAR laparoscopic low anterior resection, TaTME transanal total mesorectal excision

(17.5-28.6)

23.5

...