KEY TAKEAWAYS
- The study aimed to investigate the correlation between pelvic structure characteristics and the technical difficulty of laparoscopic sphincter-preserving radical resection for rectal cancer.
- Researchers noticed that considering the surgical approach, ostomy, sacrococcygeal distance, and pelvic inlet predicts laparoscopic sphincter-preserving surgery difficulty for rectal cancer.
Colorectal surgeons are well aware that performing surgery for rectal cancer becomes more challenging in obese patients with narrow and deep pelvic cavities. Therefore, colorectal surgeons need to comprehensively understand pelvic structure before surgery and anticipate potential surgical difficulties.
Xiao-Cong Zhou and the team aimed to assess the suitability of the surgical approach, intraoperative preventive ostomy, sacrococcygeal distance, and anterior-posterior diameter of the pelvic inlet as predictive factors for surgical difficulty.
They performed an inclusive analysis, retrospectively gathering data from 162 consecutive patients who underwent laparoscopic radical sphincter-preserving surgery for rectal cancer. Three-dimensional reconstruction of pelvic bone and soft tissue parameters was conducted using computed tomography (CT) scans. Operative difficulty was categorized as either high or low, and multivariate logistic regression analysis was employed to identify predictors of operative difficulty, ultimately creating a nomogram.
About 162 patients underwent laparoscopic radical sphincter-preserving surgery for rectal cancer. Out of these, 21 (13.0%) were classified in the high surgical difficulty group, while 141 (87.0%) were in the low surgical difficulty group. Multivariate logistic regression analysis identified laparoscopic intersphincteric dissection, intraoperative preventive ostomy, and sacrococcygeal distance as independent risk factors for highly difficult surgery (P < 0.05).
Conversely, the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance was a protective factor (P < 0.05). A constructed nomogram demonstrated good predictive accuracy (C-index = 0.834).
The study concluded that incorporating the surgical approach, intraoperative preventive ostomy, sacrococcygeal distance, and anterior-posterior diameter of pelvic inlet/sacrococcygeal distance aids in predicting the difficulty of laparoscopic radical sphincter-preserving surgery.
The study was sponsored by the Zhejiang Province Public Welfare Technology Application Research Funding Project; Basic Scientific Research Projects in Wenzhou City, Zhejiang Province; and Wenzhou Medical University 2021 Higher Education Teaching Reform Project, Zhejiang Province.
Source: https://pubmed.ncbi.nlm.nih.gov/38764764/
Zhou XC, Guan SW, Ke FY, et al. (2024). “Construction of a nomogram model to predict technical difficulty in performing laparoscopic sphincter-preserving radical resection for rectal cancer.” World J Gastroenterol. 2024 May 14;30(18):2418-2439. doi: 10.3748/wjg.v30.i18.2418. PMID: 38764764; PMCID: PMC11099392.
