{"title":"一种简单有效的评估男性中、下段直肠癌全肠系膜切除难度的方法。","authors":"X Huang, Z Xiao, Z Huang","doi":"10.1007/s10151-025-03181-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Radical resection for mid and low rectal cancer is probably the most challenging type of surgery in colorectal surgery, especially in a narrow male pelvis. In this study, we aimed to define a simple and effective evaluation method based on magnetic resonance imaging (MRI) and body mass index (BMI) to predict the operation difficulty of radical resection for mid and low rectal cancer in male patients.</p><p><strong>Methods: </strong>A total of 264 male patients who underwent total mesorectal excision (TME) due to primary rectal cancer located in the mid and low rectum (distal tumor margin distance from the anal verge ≤ 7 cm) were retrospectively included in the study. An angle SAU° [formed by two lines: line 1 (connecting the anteroinferior border of the fifth sacral vertebra and center point of anus) and line 2 (connecting internal urethral orifice and center point of anus)] was measured using the built-in software of MRI for every patient. The patients were categorized into four groups according to the angle SAU° and BMI. The operative time, estimated blood loss, TME quality, and anastomotic leakage (AL) were compared between group 1 and group 2 as well as between group 3 and group 4.</p><p><strong>Results: </strong>Group 1 included 111 patients with angle SAU° > 60 and BMI < 25 kg/m<sup>2</sup>; group 2 included 51 patients with angle SAU° ≤ 60 and BMI < 25 kg/m<sup>2</sup>; group 3 included 74 patients with angle SAU° > 60 and BMI ≥ 25 kg/m<sup>2</sup>; group 4 included 28 patients with angle SAU° ≤ 60 and BMI ≥ 25 kg/m<sup>2</sup>. The operative time, estimated blood loss, and the rate of AL in group 1 and group 3 were significantly less than those in group 2 and group 4, respectively (P < 0.05). Similarly, the TME quality in group 1 and group 3 was significantly better than that in group 2 and group 4, respectively (P < 0.05).</p><p><strong>Conclusion: </strong>Angle SAU° based on MRI combined with BMI is a simple and effective evaluation method to predict the difficulty in TME for male patients with mid and low rectal cancer. It may also have value in predicting AL.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"145"},"PeriodicalIF":2.7000,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276130/pdf/","citationCount":"0","resultStr":"{\"title\":\"A simple and effective evaluation method to determine the difficulty of total mesorectal excision for male patients with mid and lower rectal cancer.\",\"authors\":\"X Huang, Z Xiao, Z Huang\",\"doi\":\"10.1007/s10151-025-03181-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Radical resection for mid and low rectal cancer is probably the most challenging type of surgery in colorectal surgery, especially in a narrow male pelvis. In this study, we aimed to define a simple and effective evaluation method based on magnetic resonance imaging (MRI) and body mass index (BMI) to predict the operation difficulty of radical resection for mid and low rectal cancer in male patients.</p><p><strong>Methods: </strong>A total of 264 male patients who underwent total mesorectal excision (TME) due to primary rectal cancer located in the mid and low rectum (distal tumor margin distance from the anal verge ≤ 7 cm) were retrospectively included in the study. An angle SAU° [formed by two lines: line 1 (connecting the anteroinferior border of the fifth sacral vertebra and center point of anus) and line 2 (connecting internal urethral orifice and center point of anus)] was measured using the built-in software of MRI for every patient. The patients were categorized into four groups according to the angle SAU° and BMI. The operative time, estimated blood loss, TME quality, and anastomotic leakage (AL) were compared between group 1 and group 2 as well as between group 3 and group 4.</p><p><strong>Results: </strong>Group 1 included 111 patients with angle SAU° > 60 and BMI < 25 kg/m<sup>2</sup>; group 2 included 51 patients with angle SAU° ≤ 60 and BMI < 25 kg/m<sup>2</sup>; group 3 included 74 patients with angle SAU° > 60 and BMI ≥ 25 kg/m<sup>2</sup>; group 4 included 28 patients with angle SAU° ≤ 60 and BMI ≥ 25 kg/m<sup>2</sup>. The operative time, estimated blood loss, and the rate of AL in group 1 and group 3 were significantly less than those in group 2 and group 4, respectively (P < 0.05). Similarly, the TME quality in group 1 and group 3 was significantly better than that in group 2 and group 4, respectively (P < 0.05).</p><p><strong>Conclusion: </strong>Angle SAU° based on MRI combined with BMI is a simple and effective evaluation method to predict the difficulty in TME for male patients with mid and low rectal cancer. It may also have value in predicting AL.</p>\",\"PeriodicalId\":51192,\"journal\":{\"name\":\"Techniques in Coloproctology\",\"volume\":\"29 1\",\"pages\":\"145\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-07-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276130/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Techniques in Coloproctology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10151-025-03181-9\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Coloproctology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10151-025-03181-9","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
A simple and effective evaluation method to determine the difficulty of total mesorectal excision for male patients with mid and lower rectal cancer.
Background: Radical resection for mid and low rectal cancer is probably the most challenging type of surgery in colorectal surgery, especially in a narrow male pelvis. In this study, we aimed to define a simple and effective evaluation method based on magnetic resonance imaging (MRI) and body mass index (BMI) to predict the operation difficulty of radical resection for mid and low rectal cancer in male patients.
Methods: A total of 264 male patients who underwent total mesorectal excision (TME) due to primary rectal cancer located in the mid and low rectum (distal tumor margin distance from the anal verge ≤ 7 cm) were retrospectively included in the study. An angle SAU° [formed by two lines: line 1 (connecting the anteroinferior border of the fifth sacral vertebra and center point of anus) and line 2 (connecting internal urethral orifice and center point of anus)] was measured using the built-in software of MRI for every patient. The patients were categorized into four groups according to the angle SAU° and BMI. The operative time, estimated blood loss, TME quality, and anastomotic leakage (AL) were compared between group 1 and group 2 as well as between group 3 and group 4.
Results: Group 1 included 111 patients with angle SAU° > 60 and BMI < 25 kg/m2; group 2 included 51 patients with angle SAU° ≤ 60 and BMI < 25 kg/m2; group 3 included 74 patients with angle SAU° > 60 and BMI ≥ 25 kg/m2; group 4 included 28 patients with angle SAU° ≤ 60 and BMI ≥ 25 kg/m2. The operative time, estimated blood loss, and the rate of AL in group 1 and group 3 were significantly less than those in group 2 and group 4, respectively (P < 0.05). Similarly, the TME quality in group 1 and group 3 was significantly better than that in group 2 and group 4, respectively (P < 0.05).
Conclusion: Angle SAU° based on MRI combined with BMI is a simple and effective evaluation method to predict the difficulty in TME for male patients with mid and low rectal cancer. It may also have value in predicting AL.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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