Influence of computed tomography-based pelvimetric parameters and surgical approaches on surgical difficulty in mid‑low rectal cancer.

Introduction: Despite a lack of a well-defined concept of 'pelvic difficulties', pelvimetric parameters significantly influence surgical difficulty and outcomes in mid-low rectal cancer (MLRC).

Aim: The objective of this study was to explore the influence of pelvimetric parameters and surgical approaches on the difficulty of surgical procedures in MLRC.

Materials and methods: A retrospective analysis was performed at the Northern Jiangsu People's Hospital, including patients with a diagnosis of MLRC who underwent total mesorectal excision between January 2016 and June 2023. We analyzed the pelvimetric parameters and perioperative data.

Results: The study cohort comprised a total of 1138 individuals. Based on the surgical difficulty score, 374 patients were assigned to the difficult surgery (DS) group, and 764, to the non-difficult surgery group. Patients in the DS group were stratified into 2 groups based on the surgical approach: the robot-assisted laparoscopic surgery (RLS) group with 78 patients, and the conventional laparoscopic surgery group, including 296 patients. Multivariable analysis results showed that age, sex, pelvic inlet anteroposterior diameters (PIAPD), pubic symphysis height, pelvic depth, and angle A were independent influencing factors for DS.

Conclusions: Age, sex, PIAPD, pubic symphysis height, pelvic depth, and angle A were independent factors influencing DS in MLRC. In the DS group patients, RLS had certain advantages.