Influence of pelvic volume on surgical outcome after low anterior resection for rectal cancer.
BACKGROUND
Low anterior resection (LAR) for rectal cancer is a potentially challenging operation due to limited space in the pelvis. CT pelvimetry allows to quantify pelvic space, so that its relationship with outcome after LAR may be assessed. Studies investigating this, however, yielded conflicting results. We hypothesized that a small pelvis is associated with a higher rate of incomplete mesorectal excision, anastomotic leakages, and increased rate of urinary dysfunction in patients operated for rectal cancer.


METHODS
In a single-center retrospective analysis, we studied 74 patients that underwent LAR for rectal cancer with primary anastomosis. Thin-layered multi-slice CT datasets were used for slice by slice depiction of the inner pelvic surface, and the inner pelvic volume was automatically compounded. The primary outcome was quality of total mesorectal excision (TME; Mercury grading); secondary outcomes were anastomotic leakage and urinary dysfunction with regard to pelvic dimensions. Univariate analyses and multiple logistic regression analyses were performed for the primary and the secondary outcomes.


RESULTS
Shorter obstetric conjugate diameters were associated with a higher probability of a worse TME quality (110.8 ± 10.2 vs. 105.0 ± 8.6 mm; OR 0.85; 95% CI 0.73-0.99; p = 0.038). Short interspinous distance showed a trend towards an increased risk for deteriorated TME quality (OR 0.88; 95% CI 0.76-1.0; p = 0.06). Anastomotic leakage was associated with anemia (OR 2.77; 95% CI 1.0-7.7; p = 0.047). Association between pelvic diameters or pelvic volume and anastomotic leakage or urinary dysfunction was not observed. Perioperative blood transfusions were administered more often in patients with postoperative urinary dysfunction (OR 17.67; 95% CI 2.44-127.7; p = 0.004).


CONCLUSIONS
Shorter obstetric conjugate diameter might be a risk factor for incompleteness of total mesorectal excision. Anastomotic leakage seems to be influenced more by clinical factors such as anemia rather than pelvic dimensions. Further studies have to prove the influence of pelvic diameter on local recurrence of rectal cancer after LAR.
Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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Zur Hausen
Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
J
J
Gröne
Department of Radiology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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D
Kaufmann
Department of Radiology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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SM
Niehues
Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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K
Aschenbrenner
Institute of Biometry and Clinical Epidemiology, Charité Campus Mitte, Charitéplatz 1, 10098, Berlin, Germany.
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A
Stroux
Department of Radiology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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B
Hamm
Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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Kreis
Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany. johannes.lauscher@charite.de.|Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany. johannes.lauscher@charite.de.
Johannes C
JC
Lauscher
D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D015999:Multivariate Analysis; D009929:Organ Size; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D012044:Regression Analysis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Anastomotic leakage; CT pelvimetry; Completeness of mesorectal excision; Rectal cancer; Rectal resection; Urinary dysfunction