Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 7/2021

Open Access 01-07-2021 | Magnetic Resonance Imaging | Original Article

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

Authors: Jianhua Chen, Yanwu Sun, Pan Chi, Bin Sun

Published in: Surgery Today | Issue 7/2021

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Komen N, Dewint P, Van den Broeck S, Pauli S, de Schepper H. Rectal cancer surgery: what’s in a name? Acta Gastroenterol Belg. 2019;82(1):67–74.PubMed
2.
Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100(1):75–82.CrossRef
3.
van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8.CrossRef
4.
Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15(7):767–74.CrossRef
5.
Arezzo A, Passera R, Salvai A, Arolfo S, Allaix ME, Schwarzer G, et al. Laparoscopy for rectal cancer is oncologically adequate: a systematic review and meta-analysis of the literature. Surg Endosc. 2015;29(2):334–48.CrossRef
6.
van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12(6):575–82.CrossRef
7.
Bosset JF, Calais G, Mineur L, Maingon P, Stojanovic-Rundic S, Bensadoun RJ, et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol. 2014;15(2):184–90.CrossRef
8.
Baek SJ, Kim CH, Cho MS, Bae SU, Hur H, Min BS, et al. Robotic surgery for rectal cancer can overcome difficulties associated with pelvic anatomy. Surg Endosc. 2015;29(6):1419–24.CrossRef
9.
Dayal S, Battersby N, Cecil T. Evolution of surgical treatment for rectal cancer: a review. J Gastrointest Surg. 2017;21(7):1166–73.CrossRef
10.
Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, et al. Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery. 2009;146(3):483–9.CrossRef
11.
Chen W, Li Q, Fan Y, Li D, Jiang L, Qiu P, et al. Factors predicting difficulty of laparoscopic low anterior resection for rectal cancer with total mesorectal excision and double stapling technique. PLoS ONE. 2016;11(3):e151773.
12.
Escal L, Nougaret S, Guiu B, Bertrand MM, de Forges H, Tetreau R, et al. MRI-based score to predict surgical difficulty in patients with rectal cancer. Br J Surg. 2018;105(1):140–6.CrossRef
13.
De’Angelis N, Pigneur F, Martinez-Perez A, Vitali GC, Landi F, Torres-Sanchez T, et al. Predictors of surgical outcomes and survival in rectal cancer patients undergoing laparoscopic total mesorectal excision after neoadjuvant chemoradiation therapy: the interest of pelvimetry and restaging magnetic resonance imaging studies. Oncotarget. 2018;9(38):25315–31.CrossRef
14.
De’Angelis N, Pigneur F, Martinez-Perez A, Vitali GC, Landi F, Gomez-Abril SA, et al. Assessing surgical difficulty in locally advanced mid-low rectal cancer: the accuracy of two MRI-based predictive scores. Colorectal Dis. 2019;21(3):277–86.CrossRef
15.
Ishihara S, Watanabe T, Fukushima Y, Akahane T, Horiuchi A, Shimada R, et al. Safety and factors contributing to the difficulty of laparoscopic surgery for rectal cancer treated with preoperative chemoradiotherapy. Tech Coloproctol. 2014;18(3):247–55.CrossRef
16.
Chi P, Huang SH, Lin HM, Lu XR, Huang Y, Jiang WZ, et al. Laparoscopic transabdominal approach partial intersphincteric resection for low rectal cancer: surgical feasibility and intermediate-term outcome. Ann Surg Oncol. 2015;22(3):944–51.CrossRef
17.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRef
18.
Yamaoka Y, Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, et al. Mesorectal fat area as a useful predictor of the difficulty of robotic-assisted laparoscopic total mesorectal excision for rectal cancer. Surg Endosc. 2019;33(2):557–66.CrossRef
19.
Targarona EM, Balague C, Pernas JC, Martinez C, Berindoague R, Gich I, et al. Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3-dimensional reconstruction of the pelvic anatomy. Ann Surg. 2008;247(4):642–9.CrossRef
20.
Atasoy G, Arslan NC, Elibol FD, Sagol O, Obuz F, Sokmen S. Magnetic resonance-based pelvimetry and tumor volumetry can predict surgical difficulty and oncologic outcome in locally advanced mid-low rectal cancer. Surg Today. 2018;48(12):1040–51.CrossRef
21.
Sprenger T, Beissbarth T, Sauer R, Tschmelitsch J, Fietkau R, Liersch T, et al. Long-term prognostic impact of surgical complications in the German Rectal Cancer Trial CAO/ARO/AIO-94. Br J Surg. 2018;105(11):1510–8.CrossRef
22.
Salerno G, Daniels IR, Brown G, Heald RJ, Moran BJ. Magnetic resonance imaging pelvimetry in 186 patients with rectal cancer confirms an overlap in pelvic size between males and females. Colorectal Dis. 2006;8(9):772–6.CrossRef
23.
Killeen T, Banerjee S, Vijay V, Al-Dabbagh Z, Francis D, Warren S. Pelvic dimensions as a predictor of difficulty in laparoscopic surgery for rectal cancer. Surg Endosc. 2012;26(1):277.CrossRef
24.
Zhou XC, Su M, Hu KQ, Su YF, Ye YH, Huang CQ, et al. CT pelvimetry and clinicopathological parameters in evaluation of the technical difficulties in performing open rectal surgery for mid-low rectal cancer. Oncol Lett. 2016;11(1):31–8.CrossRef
25.
Prete FP, Pezzolla A, Prete F, Testini M, Marzaioli R, Patriti A, et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2018;267(6):1034–46.CrossRef
26.
Ma B, Gao P, Song Y, Zhang C, Zhang C, Wang L, et al. Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer. 2016;16:380.CrossRef
27.
Ferko A, Maly O, Orhalmi J, Dolejs J. CT/MRI pelvimetry as a useful tool when selecting patients with rectal cancer for transanal total mesorectal excision. Surg Endosc. 2016;30(3):1164–71.CrossRef
Metadata
Title
MRI pelvimetry-based evaluation of surgical difficulty in laparoscopic total mesorectal excision after neoadjuvant chemoradiation for male rectal cancer
Authors
Jianhua Chen
Yanwu Sun
Pan Chi
Bin Sun
Publication date
01-07-2021
Publisher
Springer Singapore
Published in
Surgery Today / Issue 7/2021
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-020-02211-3

Other articles of this Issue 7/2021

Surgery Today 7/2021 Go to the issue

How To Do It

Chondrotomy and sternotomy combined with the Nuss procedure for severe asymmetric pectus excavatum: how to do it

Original Article

The impact of the preoperative hand grip strength on the long-term outcomes after gastrectomy for advanced gastric cancer

Review Article

The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: a systematic review including evidence from Japan

Original Article

Effects of a high body mass index on the short-term outcomes and prognosis after radical gastrectomy

Original Article

What are the new findings with regard to the mysterious disease idiopathic granulomatous mastitis?

Original Article

The impact of early tumor shrinkage on conversion surgery and the survival in patients with unresectable locally advanced pancreatic cancer