Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication

Abstract

Maximum tumor diameter, BMI, operator experience, and tumor location can be used to predict the operative time required to complete laparoscopic anterior resection with DST anastomosis for rectal cancer, with no correlations between pelvic dimensions and operative time. The difficulty of the procedure was not related to patients' pelvic dimensions, which led us to conclude that "narrow pelvis" is not a contraindication for this surgery. Based on these results, we suggest that laparoscopic anterior resection should be performed by experienced surgeons in patients with large tumors, high BMI, and/or extraperitoneal rectal cancer.

CT/MRI pelvimetry as a useful tool when selecting patients with rectal cancer for transanal total mesorectal excision

“…Some authors have reported significant gender differences in pelvimetry measurements [20], while others have reported a significant overlap in their results and suggest that pelvimetry is a much more useful predictive tool than differences found between the sexes [21]. Tumor size, BMI, experience of the surgeon, distance of the tumor from the anal verge, dimensions of the pelvic outlet, and gender have been observed in relation to the difficulty of laparoscopic TME [6][7][8][9]. However, these studies differ considerably in their conclusions.…”

“…However, the results of clinical studies dealing with this topic have not provided sufficiently homogeneous outcomes [6][7][8][9].…”

Transanal Endoscopic Total Mesorectal Excision Combined With Single-Port Laparoscopy

“…Although no consensus exists as to the definition of a narrow pelvis, the pubiscoccyx diameter is the only pelvic diameter significantly associated with difficulties in laparoscopic total mesorectal excision. [3][4][5] Therefore, because the mean pubis-coccyx diameter has been reported to be approximately 10 cm in men, 4,5 we defined a narrow pelvis as a distance of less than 10 cm between the lower border of the pubic symphysis and the coccyx. Obesity was defined as body mass index greater than 30.…”

“…Patients were selected if they had 1 or more risk factors that would increase the difficulty of dissection of low or middle rectal cancer if a conventional laparoscopic approach were used. [3][4][5] Risk factors were defined as the presence of a narrow pelvis, a voluminous prostate, or obesity. Although no consensus exists as to the definition of a narrow pelvis, the pubiscoccyx diameter is the only pelvic diameter significantly associated with difficulties in laparoscopic total mesorectal excision.…”

“…Although laparoscopy offers a magnified image, dissection and transection of the low rectum is difficult with conventional multiport laparoscopy, particularly in obese men with a narrow pelvis. [3][4][5] A new rectal dissection technique using transanal endoscopic surgery 6-8 may reduce these difficulties. Also, the addition of single-port laparoscopic surgery may provide the same advantages as multiport laparoscopy but with a minimal number of incisions, decreased postoperative pain, and improved cosmesis.…”