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Impact of pelvic dimensions on anastomotic leak after anterior resection for patients with rectal cancer

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Abstract

Aim

The impact of pelvis on the development of anastomotic leak (AL) in rectal cancer (RC) patients who underwent anterior resection (AR) remains unclear. The aim of this study was to evaluate the impact of pelvic dimensions on the risk of AL.

Methods

A total of 1058 RC patients undergoing AR from January 2013 to January 2016 were enrolled. Pelvimetric parameters were obtained using abdominopelvic computed tomography scans.

Results

Univariate analyses showed that pelvic inlet, pelvic outlet, interspinous distance, and intertuberous distance were significantly associated with the risk for AL (P < 0.05). Multivariate analysis confirmed that pelvic inlet and intertuberous distance were independent risk factors for AL (P < 0.05). Significant factors from multivariate analysis were assembled into the nomogram A (without pelvic dimensions) and nomogram B (with pelvic dimensions). The area under curve (AUC) of nomogram B was 0.72 (95% CI 0.67–0.77), which was better than the AUC of nomogram A (0.69, [95% CI 0.65–0.74]), but didn’t reach a statistical significance (P = 0.199). Decision curve supported that nomogram B was better than nomogram A.

Conclusion

Pelvic dimensions, specifically pelvic inlet and intertuberous distance, seemed to be independent predictors for postoperative AL in RC patients. Pelvic inlet and intertuberous distance incorporated with preoperative radiotherapy, preoperative albumin, conversion, and tumor diameter in the nomogram might provide a clinical tool for predicting AL.

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References

  1. Ludwig SPMFGHK (1998) Anastomotic leakage impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis 13:160–163

    Article  Google Scholar 

  2. Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266

    Article  CAS  Google Scholar 

  3. McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102:462–479

    Article  CAS  Google Scholar 

  4. Zhou C, Wu XR, Liu XH, Chen YF, Ke J, He XW, He XS, Hu T, Zou YF, Zheng XB, Liu HS, Hu JC, Wu XJ, Wang JP, Lan P (2018) Male gender is associated with an increased risk of anastomotic leak in rectal cancer patients after total mesorectal excision. Gastroenterol Rep 6:137–143

    Article  Google Scholar 

  5. Pommergaard HC, Gessler B, Burcharth J, Angenete E, Haglind E, Rosenberg J (2014) Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis 16:662–671

    Article  CAS  Google Scholar 

  6. Parthasarathy M, Greensmith M, Bowers D, Groot-Wassink T (2017) Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17 518 patients. Colorectal Dis 19:288–298

    Article  CAS  Google Scholar 

  7. Mrak K, Uranitsch S, Pedross F, Heuberger A, Klingler A, Jagoditsch M, Weihs D, Eberl T, Tschmelitsch J (2016) Diverting ileostomy versus no diversion after low anterior resection for rectal cancer: a prospective, randomized, multicenter trial. Surgery 159:1129–1139

    Article  Google Scholar 

  8. Ihnat P, Gunkova P, Peteja M, Vavra P, Pelikan A, Zonca P (2016) Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc 30:4809–4816

    Article  Google Scholar 

  9. Zur Hausen G, Grone J, Kaufmann D, Niehues SM, Aschenbrenner K, Stroux A, Hamm B, Kreis ME, Lauscher JC (2017) Influence of pelvic volume on surgical outcome after low anterior resection for rectal cancer. Int J Colorectal Dis 32:1125–1135

    Article  CAS  Google Scholar 

  10. Targarona EM, Balague C, Pernas JC, Martinez C, Berindoague R, Gich I, Trias M (2008) 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 247:642–649

    Article  Google Scholar 

  11. Shimada T, Tsuruta M, Hasegawa H, Okabayashi K, Ishida T, Asada Y, Suzumura H, Kitagawa Y (2017) Pelvic inlet shape measured by three-dimensional pelvimetry is a predictor of the operative time in the anterior resection of rectal cancer. Surg Today 48:51–57

    Article  Google Scholar 

  12. Jeong Yeon Kim YWK, Kim NK, Hur H, KangYong Lee BSM, Cho HJ (2011) Pelvic anatomy as a factor in laparoscopic rectal surgery. Surg Laparosc Endosc Percutaneous Tech 21:334–339

    Article  Google Scholar 

  13. Kattan MW, Scardino PT (2007) Evidence for the usefulness of nomograms. Nat Clin Pract Urol 4:638–639

    Article  Google Scholar 

  14. Karakiewicz PI, Briganti A, Chun FK, Trinh QD, Perrotte P, Ficarra V, Cindolo L, De la Taille A, Tostain J, Mulders PF, Salomon L, Zigeuner R, Prayer-Galetti T, Chautard D, Valeri A, Lechevallier E, Descotes JL, Lang H, Mejean A, Patard JJ (2007) Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol 25:1316–1322

    Article  Google Scholar 

  15. Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R, Orgill DP, Group S (2017) The STROCSS statement: strengthening the Reporting of Cohort Studies in Surgery. Intl J Surg 46:198–202

    Article  Google Scholar 

  16. Ogiso S, Yamaguchi T, Hata H, Fukuda M, Ikai I, Yamato T, Sakai Y (2011) Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: "narrow pelvis" is not a contraindication. Surg Endosc 25:1907–1912

    Article  Google Scholar 

  17. Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Miyata S, Yamaguchi T (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146:483–489

    Article  Google Scholar 

  18. Eberl T, Jagoditsch M, Klingler A, Tschmelitsch J (2008) Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg 196:592–598

    Article  Google Scholar 

  19. Steffen T, Tarantino I, Hetzer FH, Warschkow R, Lange J, Zund M (2008) Safety and morbidity after ultra-low coloanal anastomoses: J-pouch vs end-to-end reconstruction. Int J Colorectal Dis 23:277–281

    Article  Google Scholar 

  20. Bhangu A, Rasheed S, Brown G, Tait D, Cunningham D, Tekkis P (2014) Does rectal cancer height influence the oncological outcome? Colorectal Dis 16:801–808

    Article  CAS  Google Scholar 

  21. Chanchan Xiao MZ, Yang X, Xiao F, Liu X, Guo Yi, Li X, Cao H, Luo J (2019) Novel nomogram with microvascular density in the surgical margins can accurately predict the risk for anastomotic leakage after anterior resection for rectal cancer. J Surg Oncol 120:1412–1419

    Article  Google Scholar 

  22. Chau J, Solomon J, Liberman AS, Charlebois P, Stein B, Lee L (2019) Pelvic dimensions on preoperative imaging can identify poor-quality resections after laparoscopic low anterior resection for mid- and low rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-019-07209-8

    Article  PubMed  Google Scholar 

  23. Atasoy G, Arslan NC, Elibol FD, Sagol O, Obuz F, Sokmen S (2018) Magnetic resonance-based pelvimetry and tumor volumetry can predict surgical difficulty and oncologic outcome in locally advanced mid-low rectal cancer. Surg Today 48:1040–1051

    Article  Google Scholar 

  24. Baik SH, Kim NK, Lee KY, Sohn SK, Cho CH, Kim MJ, Kim H, Shinn RK (2008) Factors influencing pathologic results after total mesorectal excision for rectal cancer: analysis of consecutive 100 cases. Ann Surg Oncol 15:721–728

    Article  Google Scholar 

  25. Escal L, Nougaret S, Guiu B, Bertrand MM, de Forges H, Tetreau R, Thezenas S, Rouanet P (2018) MRI-based score to predict surgical difficulty in patients with rectal cancer. Br J Surg 105:140–146

    Article  CAS  Google Scholar 

  26. Adler JT (2008) Gray's anatomy the anatomical basis of clinical practice. Elsevier, Philadelphia

    Google Scholar 

  27. Zhang X, Gao Y, Dai X, Zhang H, Shang Z, Cai X, Shen T, Cheng X, Yu K, Li Y (2018) Short- and long-term outcomes of transanal versus laparoscopic total mesorectal excision for mid-to-low rectal cancer: a meta-analysis. Surg Endosc 33:972–985

    Article  Google Scholar 

  28. Lei P, Ruan Y, Yang X, Fang J, Chen T (2018) Trans-anal or trans-abdominal total mesorectal excision? A systematic review and meta-analysis of recent comparative studies on perioperative outcomes and pathological result. Int J Surg 60:113–119

    Article  Google Scholar 

  29. Kang L, Chen WH, Luo SL, Luo YX, Liu ZH, Huang MJ, Wang JP (2016) Transanal total mesorectal excision for rectal cancer: a preliminary report. Surg Endosc 30:2552–2562

    Article  Google Scholar 

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Acknowledgements

The authors thank Dr. Jian-ping Wang for his help with study design at the beginning of this study.

Funding

This work was supported by National Key R&D Program of China (No. 2017YFC1308800), National Natural Science Foundation of China (No. 81870383), Guangdong Natural Science Foundation (Nos. 2016A030310187 and 2017A030313785), Science and Technology Planning Project of Guangzhou City (No. 201804010014).

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Author notes

  1. Zhao-liang Yu and Xuan-hui Liu contributed equally to this study.

Authors and Affiliations

  1. Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, China

    Zhao-liang Yu, Xuan-hui Liu, Hua-shan Liu, Jia Ke, Yi-feng Zou, Ping Lan, Xiao-jian Wu & Xian-rui Wu

  2. Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

    Zhao-liang Yu, Xuan-hui Liu, Hua-shan Liu, Jia Ke, Yi-feng Zou, Wu-teng Cao, Jian Xiao, Zhi-yang Zhou, Ping Lan, Xiao-jian Wu & Xian-rui Wu

  3. Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

    Jian Xiao

  4. Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

    Wu-teng Cao & Zhi-yang Zhou

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  1. Zhao-liang Yu
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Contributions

ZLY and XHL contributed to study concept and design, acquisition, analysis, and interpretation of data, and drafting of the manuscript. HSL, JK, YFZ, WTC, and ZYZ contributed to data collections and manuscript review. JX, PL, XRW and XJW contributed to study concept and design, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. XRW and XJW supervised the study. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xiao-jian Wu or Xian-rui Wu.

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Disclosures

The author Zhao-liang Yu, Xuan-hui Liu, Hua-shan Liu, Jia Ke, Yi-feng Zou, Wu-teng Cao, Jian Xiao, Zhi-yang Zhou, Ping Lan, Xiao-jian Wu, and Xian-rui Wu have no conflicts of interest or financial ties to disclose.

Informed consent

This is a retrospective trial with demonstrated minimal risk and we petition BPG for waiver of informed consent.

Institutional review board

This study was approved by the Institutional Review Board (IRB) of The Sixth Affiliated Hospital of Sun Yat-sen University.

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Xiao-jian Wu and Xian-rui Wu contributed equally to this study as co-corresponding authors.

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Yu, Zl., Liu, Xh., Liu, Hs. et al. Impact of pelvic dimensions on anastomotic leak after anterior resection for patients with rectal cancer. Surg Endosc 35, 2134–2143 (2021). https://doi.org/10.1007/s00464-020-07617-1

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  • DOI: https://doi.org/10.1007/s00464-020-07617-1

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