ArticleBJS open2023
Tumour, narrow pelvis and surgery specific factors for total mesorectal excision quality and morbidity following rectal cancer resection.
Article in BJS open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.
- Risk and protective factors for postoperative anastomotic leakage in esophageal and gastrointestinal surgery: an umbrella review of meta-analyses and systematic reviews.International journal of surgery (London, England) · 2026Pooled it
- Incremental Predictive Value of Conventional MRI Pelvimetry for Major Low Anterior Resection Syndrome After Rectal Cancer Surgery.Journal of clinical medicine · 2026Article
- Comment On: "Robotic versus laparoscopic surgery for mid and low rectal cancer: a propensity score-matched analysis of short-term outcomes and costs".Updates in surgery · 2026Article
- Impact of Hospital Volume on Local Recurrence of Rectal Cancer After Transanal Total Mesorectal Excision: A Nationwide Multicenter Cohort Study in Japan.Annals of surgical oncology · 2026Article
- Transanal versus robotic total mesorectal excision for mid- and low-rectal cancer: A single-center comparative cohort of 109 patients.Journal of robotic surgery · 2026Article
- Influence of computed tomography-based pelvimetric parameters and surgical approaches on surgical difficulty in mid‑low rectal cancer.Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques · 2025Article
- Role of pelvimetry in predicting surgical outcomes and morbidity in rectal cancer surgery: A retrospective analysis.World journal of gastrointestinal surgery · 2025Article
- Operative Time as a Universal Risk Factor for Infectious Complications after Colorectal Cancer Surgery: A Multicenter Stratified Analysis by Surgical Site.Journal of the anus, rectum and colon · 2025Article
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Authors and funding
10 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPelvic 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.
methodsPatients 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.
resultsAmong 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.
conclusionThe 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.
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