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Influence of pelvic volume on surgical outcome after low anterior resection for rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

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).

Conclusion

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.

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Author information

Author notes

  1. G. zur Hausen and J. Gröne contributed equally as first authors.

Authors and Affiliations

  1. Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany

    G. zur Hausen, J. Gröne, K. Aschenbrenner, M. E. Kreis & Johannes C. Lauscher

  2. Department of Radiology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    D. Kaufmann, S. M. Niehues & B. Hamm

  3. Institute of Biometry and Clinical Epidemiology, Charité Campus Mitte, Charitéplatz 1, 10098, Berlin, Germany

    A. Stroux

  4. Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany

    Johannes C. Lauscher

Authors
  1. G. zur Hausen
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  2. J. Gröne
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  3. D. Kaufmann
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  4. S. M. Niehues
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  5. K. Aschenbrenner
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  6. A. Stroux
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  7. B. Hamm
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  8. M. E. Kreis
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  9. Johannes C. Lauscher
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Contributions

Study conception and design were done by Lauscher JC, zur Hausen G, Groene J, Kaufmann D, Niehues SM, and Kreis ME. Acquisition of data was done by Groene J, Aschenbrenner K, and zur Hausen G. Analysis and interpretation of data was done by zur Hausen G, Lauscher JC, Groene J, and Stroux A. Drafting of the manuscript was done by zur Hausen G, Lauscher JC, Groene J, and Kaufmann D. Critical revision of the manuscript was done by Lauscher JC, Groene J, Stroux A, zur Hausen G, Aschenbrenner K, Niehues SM, Hamm B, and Kreis ME.

Corresponding author

Correspondence to Johannes C. Lauscher.

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zur Hausen, G., Gröne, J., Kaufmann, D. et al. Influence of pelvic volume on surgical outcome after low anterior resection for rectal cancer. Int J Colorectal Dis 32, 1125–1135 (2017). https://doi.org/10.1007/s00384-017-2793-9

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  • DOI: https://doi.org/10.1007/s00384-017-2793-9

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