Mesorectal fat area as a useful predictor of the difficulty of robotic-assisted laparoscopic total mesorectal excision for rectal cancer

Yamaoka, Yusuke; Yamaguchi, Takashi; Kinugasa, Yusuke; Shiomi, Akio; Kagawa, Hiroyasu; Yamakawa, Yushi; Furutani, Akira; Manabe, Shoichi; Torii, Kakeru; Koido, Kohei; Mori, Keita

doi:10.1007/s00464-018-6331-9

Cited by 42 publications

(67 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study suggested that a long sacral length and large MFA increased the surgical duration of robotic ME, in accordance with previous results [17,18]. To our knowledge, long sacral length reflects a shallow concave sacrum that may restrict the working space and increase the dissection workload, and a large area of mesorectal fat limits the space for counter traction [17]. For these reasons, both sacral length and the MFA were independent predictors for the difficulty of robotic ME.…”

Section: Discussionsupporting

confidence: 93%

Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic‐assisted mesorectal excision and intersphincteric resection respectively in different ways

et al. 2020

View full text Add to dashboard Cite

Aim Many studies have demonstrated predictors of the difficulty of laparoscopic anterior resection for rectal cancer. Few studies focus on the influence of pelvic dimensions on robotic-assisted mesorectal excision (ME) and intersphincteric resection (ISR). This study aimed to evaluate the influences of the mesorectal fat area (MFA) and mesorectal area on the difficulty of robotic sphincter-saving surgery. Methods We included 156 patients with middle and low rectal cancer who underwent robotic sphincter-saving surgery. Clinical and anatomical factors, including the pelvic dimensions, were collected. Linear regression was performed for variables associated with surgical duration. We also performed subgroup analyses for robotic-assisted ME and ISR. Logistic regression was used to find variables associated with transanal dissection. Results For patients with middle or low rectal cancer, the sacral length and tumour distance from the anal verge were independently associated with surgical duration. The pT stage, sacral length and the MFA were independent predictors for the surgical duration of robotic-assisted ME. By contrast, a small mesorectal area was independently related to a longer duration of robotic-assisted ISR. The pelvic outlet length was independently associated with the use of transanal dissection for ISR. Conclusion It is suggested that a large MFA could affect the difficulty of ME in robotic-assisted ME, while a small mesorectal area could increase the surgical difficulty of robotic-assisted ISR for low rectal cancer. Besides, the pelvic outlet length was associated with the use of transanal dissection. Further studies are needed to validate the results and draw more scientific conclusions.

show abstract

Section: Discussionsupporting

confidence: 93%

Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic‐assisted mesorectal excision and intersphincteric resection respectively in different ways

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The association between prolonged operative time and anasotmotic leak following esophagectomy, while also a novel finding, is more straightforward . Intuitively, longer operative times may frequently represent more technically challenging cases, which could inherently be expected to have an increased risk of anastomotic complications.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, others have also reported that anatomic factors significantly influence operative time and reflect operative complexity for rectal and hepatic resections. However, Patoir et al found that surgeon characteristics and center location accounted for 32% and 29%, respectively, of operative time variation during thyroid surgery, suggesting that factors other than operative complexity may also contribute to operative time. In consideration of the above, the etiology of prolonged operative time is likely multifactorial and varies across surgical settings.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hall

Flores

Parshall

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak.Methods: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak.Results: Of 915 patients included, 83% were male and the median age was 64 years.Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak.Conclusion: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.

show abstract

“…If this applies for a proctoscope, it would be consistent to find a difference also when a flexible or rigid trans-anal platform is placed and used in procedures where dissection is based on geometrical tips (the so-called O and triangle dissection planes) [5] and on a dynamic anatomic distortion made by the pneumorectum [5]. Several authors correlated the anatomical variables with surgical results, for open, robotics, laparoscopic, and TaTME dissections [8,[17][18][19][20][21][22][23][24]. In a small series of patients who underwent open surgery for low rectal tumours, no significant differences were detected between the pelvis depth of females and males.…”

Section: Discussionmentioning

confidence: 92%

3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections

Lorenzon

Bini

Landolfi

et al. 2020

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution. Methods A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx’s tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses. Results Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape. Conclusion Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.

show abstract

Mesorectal fat area as a useful predictor of the difficulty of robotic-assisted laparoscopic total mesorectal excision for rectal cancer

Abstract: Mesorectal fat area may serve as a useful predictor of the difficulty of total mesorectal excision for rectal cancer.

Cited by 42 publications

References 32 publications

Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic‐assisted mesorectal excision and intersphincteric resection respectively in different ways

Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic‐assisted mesorectal excision and intersphincteric resection respectively in different ways

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections

Contact Info

Product

Resources

About