Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
BJS Open. 2023 Nov 1;7(6). doi: 10.1093/bjsopen/zrad114.
Pelvic anatomy is critical in challenging rectal resections. This study investigated how pelvic anatomy relates to total mesorectal excision (TME) quality, anastomotic leakage rate, and long-term oncological outcomes.
Patients undergoing elective rectal cancer resection from 2008 to 2017 in an Austrian institution were retrospectively reviewed regardless of the surgical approach. CT scans were analysed for pelvic measurements and volumes. The primary outcomes of interest were the correlation between pelvic dimensions and the TME quality and anastomotic leakage. Subanalysis was done by surgical approach (open, laparoscopic, transanal TME). Secondary outcomes were overall and disease-free survivals.
Among 154 eligible patients, 112 were included. The angle between pubic symphysis and promontory significantly correlated with worse TME grades (TME grade 1: mean(s.d.) 102.7(5.7)°; TME grade 2: 92.0(4.4)°; TME grade 3: 91.4(3.6)°; P < 0.001). A significantly lower distance between tumour and circumferential resection margin (CRM) was observed in grade 3 resections, whereas no difference appeared in grade 1 and grade 2 resection (TME grade 1: mean(s.d.) 11.92(9.4) mm; TME grade 2: 10.8(8.1) mm; TME grade 3: 3.1(4.1) mm; P = 0.003). The anastomotic leakage rate was significantly higher in case of a lower CRM (patients with anastomotic leakage: mean(s.d.) 6.8(5.8) mm versus others: 12.6(9.8) mm, P = 0.027), but not associated with pelvimetry measurements. The transanal TME (TaTME) subgroup displayed a wider angle between the pubic symphysis and promontory, younger age and improved TME quality compared to others (respectively, mean TME grades in TaTME versus open versus laparoscopic: 1.0 ± 0.0, 1.5 ± 0.7 and 1.3 ± 0.5, P = 0.013). Finally, oncological survival was not impacted by pelvic measurements or worse TME quality.
The angle between the pubic symphysis and promontory and the distance between tumour and CRM were associated with worse TME grades. The anastomotic leakage was associated with a lower CRM but not with pelvimetric measures.
盆腔解剖在直肠切除术方面具有重要意义。本研究旨在探讨盆腔解剖与全直肠系膜切除术（TME）质量、吻合口漏发生率和长期肿瘤学结果的关系。
回顾性分析 2008 年至 2017 年在奥地利一家机构接受择期直肠切除术的患者，无论手术方式如何均纳入研究。对 CT 扫描进行盆腔测量和体积分析。主要研究结果为盆腔测量与 TME 质量和吻合口漏的相关性。通过手术方式（开腹、腹腔镜、经肛门 TME）进行亚分析。次要结果为总生存和无病生存。
在 154 名符合条件的患者中，纳入了 112 名患者。耻骨联合与穹窿之间的角度与较差的 TME 分级显著相关（TME 分级 1：平均（标准差）102.7（5.7）°；TME 分级 2：92.0（4.4）°；TME 分级 3：91.4（3.6）°；P<0.001）。在 TME 分级 3 中，肿瘤与环周切缘（CRM）之间的距离明显更低，而 TME 分级 1 和分级 2 之间无差异（TME 分级 1：平均（标准差）11.92（9.4）mm；TME 分级 2：10.8（8.1）mm；TME 分级 3：3.1（4.1）mm；P=0.003）。较低的 CRM 与更高的吻合口漏发生率相关（吻合口漏患者：平均（标准差）6.8（5.8）mm 与其他患者：12.6（9.8）mm，P=0.027），但与盆腔测量无关。与其他患者相比，经肛门 TME（TaTME）亚组的耻骨联合与穹窿之间的角度更宽，年龄更小，TME 质量更好（分别为 TaTME 中的平均 TME 分级与开腹、腹腔镜：1.0±0.0、1.5±0.7 和 1.3±0.5，P=0.013）。最后，盆腔测量或较差的 TME 质量并不影响肿瘤学生存。
耻骨联合与穹窿之间的角度和肿瘤与 CRM 之间的距离与较差的 TME 分级相关。吻合口漏与较低的 CRM 相关，但与盆腔测量值无关。
