Pelvic imaging anatomy study on the difficulty of laparoscopic ISR surgery for ultra-low rectal cancer

doi:10.3877/cma.j.issn.1674-3946.2025.03.020.

Abstract

Abstract:

Objective

To study the imaging anatomy of the pelvis during laparoscopic ultra low rectal resection （ISR）.

Methods

Data of 101 patients with ultra-low rectal cancer who underwent laparoscopic ISR from December 2019 to January 2024 were retrospectively analyzed.According to the surgical difficulty score，41 cases were divided into high difficulty group and 60 cases were divided into low difficulty group.SPSS 22.0 analyzed the data.Perioperative indicators，pelvimetry data and other measurement data were expressed as（±s），and independent sample t test was performed.The number of lymph node dissection was expressed as the median （interquartile）.χ² test was used for counting data combined with basic diseases.Logistics regression analysis of the factors affecting the difficulty of surgery.P＜0.05 indicated that the difference was statistically significant.

Results

There were significant differences in operation time，intraoperative blood loss，hospital stay and complication grade between the two groups （P＜0.05）.Sacrococcygeal arc length SL （t=9.832，P=0.000），anteroposterior diameter of pelvic outlet ADPO （t=-4.470，P=0.000），anteroposterior diameter of pelvic entrance ADPE （t=-3.095，P=0.030），anteroposterior diameter of middle pelvis ADMP （t=-3.442，P=0.000），and anteroposterior diameter of pelvic outlet ADPO （t=-4.470，P=0.000） were observed in the advanced difficulty group.P=0.000），upper and lower diameter SPD of symphysis pubis （t=-4.156，P=0.000），intertubercular diameter IID （t=-2.043，P=0.044） were statistically significant.Logistic regression analysis showed that the anterior and posterior diameter of the middle pelvis and the interischial diameter IID were independent protective factors for ISR of laparoscopic ultra-low rectal cancer.Sacrococcygeal arc length SL and male pelvic characteristics were independent risk factors for ISR of laparoscopic ultra-low rectal cancer （P＜0.05）.

Conclusion

CT three-dimensional reconstructed pelviometry can predict the difficulty of surgery.The shorter the anteroposterior diameter of the middle pelvis and the diameter between the ischial tubercle，the longer the sacrococcygeal arc length，and the more difficult the operation of ISR for ultra-low rectal cancer.

Key words: Ultra-Low Rectal Tumor, Intersphincteric Resection(ISR), Laparoscopes, CT Three-Dimensional Pelvis Measurement

Liangliang Chen, Lei Guo, Wensi Liu, Congwen Jin. Pelvic imaging anatomy study on the difficulty of laparoscopic ISR surgery for ultra-low rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 305-308.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.03.020.

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I03/305

Figures/Tables 5

组别	例数	性别（例）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	年龄（岁， $\overset{ˉ}{x}$ ±s）	肿瘤分期（例）Ⅰ/Ⅱ
组别	例数	男/女	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	年龄（岁， $\overset{ˉ}{x}$ ±s）	肿瘤分期（例）Ⅰ/Ⅱ
高难度组	41	30/11	22. 6±3. 1	68. 2±9. 8	24/17
低难度组	60	23/37	22. 4±3. 2	67. 8±10. 3	20/40
χ ²/t值		11. 853	0. 312	0. 195	0. 993
P值		0. 000	0. 755	0. 845	0. 319
组别	例数	肿瘤大小（cm， $\overset{ˉ}{x}$ ±s）	距离肛门位置（例）		肿瘤分化程度（例）
组别	例数	肿瘤大小（cm， $\overset{ˉ}{x}$ ±s）	3∽5（cm）/	≤3（cm）	中/高
高难度组	41	3. 2±0. 8	17/	24	21/20
低难度组	60	3. 4±0. 7	32/	28	41/19
χ ²/t值		-1. 322	1. 374		3. 010
P值		0. 189	0. 241		0. 083

组别	例数	性别（例）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	年龄（岁， $\overset{ˉ}{x}$ ±s）	肿瘤分期（例）Ⅰ/Ⅱ
组别	例数	男/女	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	年龄（岁， $\overset{ˉ}{x}$ ±s）	肿瘤分期（例）Ⅰ/Ⅱ
高难度组	41	30/11	22. 6±3. 1	68. 2±9. 8	24/17
低难度组	60	23/37	22. 4±3. 2	67. 8±10. 3	20/40
χ ²/t值		11. 853	0. 312	0. 195	0. 993
P值		0. 000	0. 755	0. 845	0. 319
组别	例数	肿瘤大小（cm， $\overset{ˉ}{x}$ ±s）	距离肛门位置（例）		肿瘤分化程度（例）
组别	例数	肿瘤大小（cm， $\overset{ˉ}{x}$ ±s）	3∽5（cm）/	≤3（cm）	中/高
高难度组	41	3. 2±0. 8	17/	24	21/20
低难度组	60	3. 4±0. 7	32/	28	41/19
χ ²/t值		-1. 322	1. 374		3. 010
P值		0. 189	0. 241		0. 083

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	术中出血量（ml， $\overset{ˉ}{x}$ ±s）	淋巴结清扫数目（枚）
高难度组	41	218. 5±20. 2	43. 6±4. 5	12（5，15）
低难度组	60	178. 5±18. 2	35. 6±3. 7	11（6，19）
χ2/t值		10. 372	9. 767	1. 624
P值		0. 000	0. 000	0. 347
组别	例数	住院时间（d， $\overset{ˉ}{x}$ ±s）	并发症分级（例）	中转开腹（例）
组别	例数	住院时间（d， $\overset{ˉ}{x}$ ±s）	Ⅱ /Ⅲ	中转开腹（例）
高难度组	41	7. 5±0. 6	12/29	5
低难度组	60	6. 5±0. 7	42/18	1
χ2/t值		7. 462	16. 242	3. 131
P值		0. 000	0. 000	0. 077

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	术中出血量（ml， $\overset{ˉ}{x}$ ±s）	淋巴结清扫数目（枚）
高难度组	41	218. 5±20. 2	43. 6±4. 5	12（5，15）
低难度组	60	178. 5±18. 2	35. 6±3. 7	11（6，19）
χ2/t值		10. 372	9. 767	1. 624
P值		0. 000	0. 000	0. 347
组别	例数	住院时间（d， $\overset{ˉ}{x}$ ±s）	并发症分级（例）	中转开腹（例）
组别	例数	住院时间（d， $\overset{ˉ}{x}$ ±s）	Ⅱ /Ⅲ	中转开腹（例）
高难度组	41	7. 5±0. 6	12/29	5
低难度组	60	6. 5±0. 7	42/18	1
χ2/t值		7. 462	16. 242	3. 131
P值		0. 000	0. 000	0. 077

组别	例数	ADPE	PETD	ADPO	ADMP
高难度组	41	104. 5±10.1	105. 6±6. 4	89. 6±9. 6	95. 1±8. 2
低难度组	60	111. 1±10.8	107. 5±7. 2	99. 3±11. 4	101. 2±9. 1
χ ²/t值		-3. 095	-1. 361	-4. 470	-3. 442
P值		0. 030	0. 177	0. 000	0. 000
组别	例数	SHP	IID	SL	SPD
高难度组	41	46. 9±8. 3	96. 5±9. 6	124. 3±13. 3	33. 4±3. 2
低难度组	60	46. 8±8. 5	100. 7±10. 5	100. 1±11. 3	36. 3±3. 6
χ ²/t值		0. 059	-2. 043	9. 832	-4. 156
P值		0. 953	0. 044	0. 000	0. 000

因素	B值	SE值	Waldχ²值	P值	OR　值（95％CI）
性别（男vs. 女）	0. 249	0. 184	2. 356	0. 041	0. 674　（0. 287-0. 799）
ADPE（mm）	1. 044	0. 157	1. 287	0. 119	0. 562　（0. 221-1. 488）
ADPO（mm）	0. 887	0. 847	1. 398	0. 108	0. 431　（0. 103-1. 657）
ADMP（mm）	-0. 734	0. 518	1. 547	0. 013	0. 987　（0. 152-0. 999）
IID（mm）	-0. 847	0. 457	2. 337	0. 007	0. 845　（0. 265-0. 947）
SL（mm）	0. 545	0. 219	5. 177	0. 027	1. 455　（1. 061-1. 987）
SPD（mm）	0. 367	0. 355	1. 741	0. 127	0. 560　（0. 126-1. 289）

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