Journal of St. Marianna University
Online ISSN : 2189-0277
Print ISSN : 2185-1336
ISSN-L : 2185-1336
original article
CT-Determined Area of the Pelvis Occupied by an Upper Rectal Tumor as a Predictor of Surgical Difficulty in Patients Undergoing Laparoscopic Rectal Resection
Yoshitsugu TsukamotoRyoji MakizumiTakehito OtsuboYuta Ogura
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2019 Volume 10 Issue 2 Pages 71-79


Objectives Laparoscopic surgery is widely used for treatment of colorectal cancer. However, due to the restricted operating space in patients with rectal cancer, the degree of surgical difficulty is greater than that in patients with colon cancer. For assistance in planning the surgery, we have calculated the pelvic volume, rectal volume, and tumor volume to derive occupancy of the rectum and tumor in the pelvic cavity. In the study described herein, we calculated the rectal tumor area and pelvic area by measuring the maximum diameter of the rectal tumor and the diameter of the pelvis on selected computed tomography (CT) slices and the analyzed these areas in relation to surgical outcomes.
Methods Sixty-two patients diagnosed with upper rectal cancer at St. Marianna University Hospital between October 2012 and December 2018 were included in the study. All were treated by laparoscopic surgery, having undergone computed tomography colonography (CTC) preoperatively. We calculated the rectal volume occupancy and rectal area occupancy and performed statistical analyses to determine whether a relation exists between these measurements and the surgical difficulty encountered or incidence of anastomotic leakage.
Results Significant positive correlation (r = 0.603, p < 0.01) was found between area occupancy and volume occupancy. Surgical difficulty, as evidenced by a relatively high blood loss volume, was significantly increased among patients with an area occupancy ≥ 52.54% (p = 0.0146). The incidence of anastomotic leakage was significantly high among patients with high area occupancy (p = 0.011) and particularly high in those with area occupancy ≥ 52.54%.
Conclusion The rectal area occupancy determined by means of CTC is a useful predictor of the frequency of complications and level of surgical difficulty in patients with upper rectal cancer treated laparoscopically.

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© 2019 St. Marianna University Society of Medical Science
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