Abstract
Background
Total mesorectal excision (TME) is challenging to perform in a deep, narrow pelvis. While previous studies used pelvimetry to assess bony pelvic structures, there is no consensus on exact definition of deep, narrow pelvis. We hypothesized that the shape of pelvic floor muscle may impact the performance of transabdominal pelvic dissection. We aimed to evaluate which parameters of the shape of pelvic floor muscle impact the difficulty of TME and present a predictive reference value for TME difficulty.
Methods
From January 2015 to December 2015, 85 consecutive patients who had undergone curative resection for middle to lower rectal cancer were retrospectively studied. Pelvimetry was performed using preoperative T2-weighted magnetic resonance imaging. Predictive factor analysis for surgical duration was studied using linear regression. Mann–Whitney U test, comparing surgical duration between two groups classified by predictive factor, was used for the analysis of reference value.
Results
Multivariate analysis revealed that body mass index, protective stoma, number of surgeon, and incline angle of pelvic floor muscle (β) were independent predictors of surgical duration. Test statistics of Mann–Whitney U for the difference in surgical duration between groups above and below a β of 54° were maximized.
Conclusions
The incline angle of pelvic floor muscle is an independent predictor of surgical duration. In patients with steeper incline of PFM, transabdominal TME is expected to be difficult. This index is novel, but needs to be further validated.
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Acknowledgements
The authors would like to thank Joon Seok Lim, the radiologist for methodological advice in pelvimetry, for helping with this study. Financial support for English proofreading was provided by Yonsei University College of Medicine.
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Contributions
Conception and design: JML and NKK; Collection and assembly of data: JML; Data analysis and interpretation: JML, YDH, MSC, HH, BSM, and KYL.; Manuscript writing: All authors; Final approval of manuscript: All authors.
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Jong Min Lee, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, and Nam Kyu Kim have no conflicts of interest or financial ties to disclose.
Ethics approval
The study protocol was approved by the Institutional Review Board at Human Research Protection Center of Severance Hospital in Seoul, South Korea (4-2018-0447). Informed consent was waived due to the retrospective analysis of this study.
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Lee, J.M., Han, Y.D., Cho, M.S. et al. Prediction of transabdominal total mesorectal excision difficulty according to the angle of pelvic floor muscle. Surg Endosc 34, 3043–3050 (2020). https://doi.org/10.1007/s00464-019-07102-4
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DOI: https://doi.org/10.1007/s00464-019-07102-4