MRI pelvimetry-based evaluation of surgical difficulty in laparoscopic total mesorectal excision after neoadjuvant chemoradiation for male rectal cancer

Abstract

Purpose Laparoscopic total mesorectal excision (LaTME) is technically demanding in rectal cancer after neoadjuvant chemoradiotherapy (NCRT). This study aimed to predict the surgical difficulty of LaTME after NCRT based on pelvimetric parameters. Methods This study enrolled 147 patients who underwent LaTME after NCRT. The surgical difficulty was graded as high or low according to the operative time, estimated blood loss, conversion to open surgery, postoperative hospital stay, and postoperative complications. Pelvimetry parameters were collected based on preoperative MRI. A logistic regression analysis was performed to identify predictors of high surgical difficulty, and a nomogram was developed. Results Totally, 18 (12.2%) patients were graded as high surgical difficulty. High surgical difficulty was correlated with a shorter interspinous distance (P = 0.014), a small angle α and γ (P = 0.008, P = 0.008, respectively), and a larger mesorectal area and mesorectal fat area (P = 0.041, P = 0.046, respectively). Tumor distance from the anal verge (OR = 0.619, P = 0.024), tumor diameter (OR = 3.747, P = 0.004), interspinous distance (OR = 0.127, P = 0.007), and angle α (OR = 0.821, P = 0.039) were independent predictors of high surgical difficulty. A predictive nomogram was developed with a C-index of 0.867. Conclusion A shorter tumor distance from the anal verge, larger tumor diameter, shorter interspinous distance, and smaller angle α could help to predict high surgical difficulty of LaTME in male LARC patients after NCRT.

Advances in pelvic imaging parameters predicting surgical difficulty in rectal cancer

“…The ischial spine spacing shows a trend toward an increased risk of TME specimen quality decline, and a shorter ischial spine spacing may be an independent risk factor for poor surgical quality [ 24 ]. Other research has also confirmed this [ 26 ]. Compared to open surgery, in the most distal anatomy of the mesorectum, lapTME is difficult to perform due to the curved angle of the sacrococcygeal bone, which can easily lead to low-quality TME specimens and increased rates of circumferential resection margin positivity [ 24 , 30 ].…”

“…1 ) [ 7 , 19 ] (k) Mesorectal fat area The area of mesangium and fat around the rectum at the level of the tip of the sciatic spine (Fig. 3 ) [ 13 , 23 , 25 , 26 ] (l) Angle T4 The angle between the upper and lower borders of the pubic symphysis with the lower border of the tumor as the vertex (Fig. 4 ) [ 31 ] (m) Angle A5 The angle between the line connecting the upper and lower borders of the pubic symphysis and the line connecting the midpoint of the upper border of the pubic symphysis to the sacral promontory (Fig.…”

“…Other studies predicting the difficulty of laparoscopic rectal cancer surgery still concluded that a smaller pelvis increased the operative time [ 5 , 8 ]. Based on this, several recent studies have established models for predicting surgical difficulty, but external validation is still lacking [ 26 – 28 ]. In addition, it is worth mentioning that, anatomically, women have wider and shallower pelvises than men, so such surgical procedures may be easier to perform in female patients, and some research has confirmed this point [ 7 ].…”

Evaluation of Nursing Effects of Pelvic Floor Muscle Rehabilitation Exercise on Gastrointestinal Tract Rectal Cancer Patients Receiving Anus‐preserving Operation by Intelligent Algorithm‐based Magnetic Resonance Imaging

“…Defecation habits of patients are often changed in the middle phase of RC, such as slenderer or flatter stools. Some patients suffer from defecation frequency, tenesmus, anus discomfort, and hypogastrium pain [ 20 ]. At an advanced phase, bloody stool or mucus usually appears.…”

BMI and pelvimetry help to predict the duration of laparoscopic resection for low and middle rectal cancer

“…Moreover, the median operative time and postoperative hospital stay were 310 min and 18 days, respectively, so those criteria were also adjusted accordingly. However, in the studies by Sun [ 18 ] and Chen [ 16 ], the average postoperative hospital stay was 8.0 days and 7.7 days, respectively. As a result, these authors adjusted the standard critical value of postoperative hospital stay to 7 days for analysis.…”