Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 773-786
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.773
Study on sex differences and potential clinical value of three-dimensional computerized tomography pelvimetry in rectal cancer patients
Xiao-Cong Zhou, Fei-Yue Ke, Gaurav Dhamija, Hao Chen, Qiang Wang
Xiao-Cong Zhou, Department of Colorectal Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
Fei-Yue Ke, Hao Chen, Postgraduate Training Base Alliance of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
Gaurav Dhamija, School of International Studies, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Qiang Wang, Department of Radiology, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
Co-first authors: Xiao-Cong Zhou and Fei-Yue Ke.
Author contributions: Zhou XC and Ke FY performed the literature review and drafted and revised the manuscript; Dhamija G, Chen H, and Wang Q participated in the study’s design and revised the manuscript for intellectual content; All authors reviewed the manuscript and approved the final manuscript.
Supported by 2021 Zhejiang Province Public Welfare Technology Application Research Funding Project, No. LGC21H160002; Basic Scientific Research Projects in Wenzhou City in 2022, No. Y20220885; and Wenzhou Medical University 2021 Higher Education Teaching Reform Project, No. JG2021167.
Institutional review board statement: The study was reviewed and approved by the Wenzhou Central Hospital Institutional Review Board (Approval No. K2018-01-003).
Informed consent statement: Due to the retrospective cohort study design, the need for informed consent was waived by the Wenzhou Central Hospital Institutional Review Board.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiang Wang, MD, Attending Doctor, Department of Radiology, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), No. 252 Baili East Road, Wenzhou 325000, Zhejiang Province, China. franklin1216@sina.com
Received: November 9, 2023
Peer-review started: November 9, 2023
First decision: December 6, 2023
Revised: December 16, 2023
Accepted: January 15, 2024
Article in press: January 15, 2024
Published online: March 15, 2024
Processing time: 123 Days and 23 Hours
Abstract
BACKGROUND

Laparoscopic rectal cancer radical surgery is a complex procedure affected by various factors. However, the existing literature lacks standardized parameters for the pelvic region and soft tissues, which hampers the establishment of consistent conclusions.

AIM

To comprehensively assess 16 pelvic and 7 soft tissue parameters through computerized tomography (CT)-based three-dimensional (3D) reconstruction, providing a strong theoretical basis to address challenges in laparoscopic rectal cancer radical surgery.

METHODS

We analyzed data from 218 patients who underwent radical laparoscopic surgery for rectal cancer, and utilized CT data for 3D pelvic reconstruction. Specific anatomical points were carefully marked and measured using advanced 3D modeling software. To analyze the pelvic and soft tissue parameters, we employed statistical methods including paired sample t-tests, Wilcoxon rank-sum tests, and correlation analysis.

RESULTS

The investigation highlighted significant sex disparities in 14 pelvic bone parameters and 3 soft tissue parameters. Males demonstrated larger measurements in pelvic depth and overall curvature, smaller measurements in pelvic width, a larger mesorectal fat area, and a larger anterior-posterior abdominal diameter. By contrast, females exhibited wider pelvises, shallower depth, smaller overall curvature, and an increased amount of subcutaneous fat tissue. However, there were no significant sex differences observed in certain parameters such as sacral curvature height, superior pubococcygeal diameter, rectal area, visceral fat area, waist circumference, and transverse abdominal diameter.

CONCLUSION

The reconstruction of 3D CT data enabled accurate pelvic measurements, revealing significant sex differences in both pelvic and soft tissue parameters. This study design offer potential in predicting surgical difficulties and creating personalized surgical plans for male rectal cancer patients with a potentially “difficult pelvis”, ultimately improving surgical outcomes. Further research and utilization of these parameters could lead to enhanced surgical methods and patient care in laparoscopic rectal cancer radical surgery.

Keywords: Computerized tomography; Rectal cancer; Three-dimensional reconstruction; Pelvimetry; Sex differences

Core Tip: This study utilized three-dimensional computerized tomography reconstruction to comprehensively evaluate 16 pelvic and 7 soft tissue parameters in 218 rectal cancer patients undergoing laparoscopic surgery. Significant sex differences were found in 14 pelvic and 3 soft tissue parameters. Females exhibited wider, shallower pelvises with smaller overall curvature compared to males. Males had narrower, deeper pelvises with greater curvature and increased mesorectal fat. These findings can help predict surgical difficulties in males with a potentially “difficult pelvis” to guide operative planning and improve outcomes.