Role of pelvimetry in predicting surgical outcomes and morbidity in rectal cancer surgery: A retrospective analysis

doi:10.4240/wjgs.v17.i4.104726

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Apr 27, 2025; 17(4): 104726
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.104726

Table 1 Distribution of demographic, surgical, pathological, clinical, and radiological characteristics of the patients included in the study

Items	Value
Age (years; n = 79)	66.32 ± 11.87
Gender (n = 79)
Male	54 (68.35)
Female	25 (31.65)
BMI (kg/m²; n = 73)	25.90 (19:44)
Tumor localization (n = 79)
Upper rectum	30 (37.97)
Middle rectum	16 (20.25)
Lower rectum	33 (41.77)
ASA score (n = 78)
I	1 (1.28)
II	30 (38.46)
III	46 (58.97)
IV	1 (1.28)
Operation type (n = 79)
Open low anterior	36 (45.57)
Laparoscopic low anterior	37 (46.84)
Miles	6 (7.59)
Operation time (min; n = 78)	237.12 ± 59.82
Blood loss cc (n = 78)	125 (50:200)
Tumor stage (n = 78)
0	5 (6.41)
1	21 (26.92)
2A	17 (21.79)
2B	3 (3.85)
3A	14 (17.95)
3B	9 (11.54)
3C	9 (11.54)
Tumor size (cm; n = 77)	3.50 (0:17)
Pelvic inlet area-CT mm² (n = 77)	8428.65 ± 1232.66
Fecal diversion (n = 73)
Exist	48 (65.75)
None	20 (27.40)
Lymphovascular invasion (n = 74)	23 (29.90)
Average number of lymph nodes dissected (n = 77)	14.75 ± 7.99
PCI (n = 52)	10.40 ± 2
Neoadjuvant therapy (n = 79)	38 (48.10)
Adjuvant therapy (n = 74)	50 (67.60)
Follow-up period (months; n = 75)	32 (0:70)

Data are expressed as n (%), mean ± SD, and median (minimum:maximum). ASA: American Society of Anesthesiologists; CT: Computed tomography; BMI: Body mass index; PCI: Pelvic cavity index.

Table 2 Comparisons based on demographic, pathological, and clinical variables among patient groups formed according to computed tomography measurements

	n	Narrow	n	Normal	P value
Age (years)	48	67.13 ± 11.84	29	64.86 ± 11.96	0.421^a
Gender (n = 79)
Male	48	39 (81.25)	29	14 (48.28)	0.002^b
Female	48	9 (18.75)	29	15 (51.72)	0.002^b
BMI (kg/m²)	46	25.42 ± 3.96	2	28.93 ± 5.15	0.002^a
Tumor localization
Upper rectum	48	20 (41.67)	29	10 (34.48)	0.532^b
Middle rectum		11 (22.92)		5 (17.24)
Lower rectum		17 (35.42)		14 (48.27)
ASA score
I	48	1 (2.08)	28	0	0.318^c
II		15 (31.25)		14 (50)
III		31 (64.58)		14 (50)
IV		1 (2.08)		0
Operation type
Open low anterior	48	24 (50)	29	11 (37.93)	0.281^c
Laparoscopic low anterior		22 (45.83)		14 (48.28)
Miles		2 (4.17)		4 (13.79)
Tumor stage
0	47	1 (2.13)	29	4 (13.79)	0.604^c
1		13 (27.66)		8 (27.59)
2A		11 (23.40)		6 (20.69)
2B		2 (4.26)		1 (3.45)
3A		7 (14.89)		5 (17.24)
3B		6 (12.77)		3 (10.34)
3C		7 (14.89)		2 (6.90)
Tumor size (cm)	46	4 (0:17)	29	3 (0:7)	0.052^d
PCI	31	10.13 ± 1.99	21	10.80 ± 2	0.236^a

^aIndependent samples t-test.

^bχ² test.

^cFisher-Freeman-Halton test.

^dMann-Whitney U test.

Data are expressed as n (%), mean ± SD, and median (minimum:maximum). ASA: American Society of Anesthesiologists; BMI: Body mass index; PCI: Pelvic cavity index.

Table 3 Comparison of surgical outcomes among patient groups formed according to computed tomography measurements

	n	Narrow	n	Normal	P value
Operation time (min)	47	237.66 ± 57.43	29	233.97 ± 65.33	0.797^a
Blood loss (cc)	48	137.50 (50:200)	28	125 (50:200)	0.723^d
Length of stay (day)	48	8 (4:32)	29	7 (4:21)	0.462^d
Readmission
Exist	44	8 (53.33)	28	7 (46.67)	0.487^b
None	44	36 (63.16)	28	21 (36.84)	0.487^b
Dissected lymph nodes	46	15 (1:42)	29	13 (2:30)	0.229^d
Pelvic infection
Exist	48	6 (60)	29	4 (40)	> 0.99^c
None	48	42 (62.69)	29	25 (37.31)	> 0.99^c
Recurrence	45	9 (20)	30	6 (20)	0.943^b
Anastomosis leakage	44	5 (62.50)	26	3 (37.50)	> 0.99^c
Perioperative morbidity	48	19 (70.37)	29	8 (29.63)	0.285^b
Surgical mortality	48	1 (50)	29	1 (50)	0.645^c

^aIndependent sample t test.

^bχ² test.

^cFisher's exact χ² test.

^dMann Whitney U test.

Data are expressed as n (%), mean ± SD, and median (minimum:maximum).

Table 4 Comparisons between patient groups with or without perioperative morbidity

	n	Exist	n	None	P value
Age (year)	27	71.70 ± 9.16	52	63.52 ± 12.22	0.003^a
Gender
Male	27	23 (85.19)	52	31 (59.62)	0.020^b
Female	27	4 (14.81)	52	21 (40.38)	0.020^b
BMI (kg/m²)	23	27.60 (19:44)	50	24.90 (19.50:37.70)	0.316^d
Tumor localization
Upper rectum	27	12 (44.44)	52	18 (34.62)	0.588^b
Middle rectum		4 (14.81)		12 (23.08)
Lower rectum		11 (40.74)		22 (42.31)
ASA score
I	27	0	51	1 (1.96)	0.583^c
II		11 (40.74)		19 (37.25)
III		15 (55.56)		31 (60.78)
IV		1 (3.70)		0
Operation time (min)	27	240 (130:360)	51	240 (150:360)	0.782^d
Blood loss (cc)	26	137.50 (50:200)	52	125 (50:200)	0.355^d
Tumor size	25	3.50 (0.03:17)	52	3.75 (0:8.40)	0.836^d
Pelvic inlet area-CT (mm²)	27	8449.29 ± 1043.45	50	8417.50 ± 1333.64	0.915^a
Number of dissected lymph nodes	25	13 (3:32)	52	15 (1:42)	0.372^d
PCI	17	9.62 ± 1.74	35	10.78 ± 2.03	0.049^a

^aIndependent samples t-test.

^bχ² test.

^cFisher-Freeman-Halton test.

^dMann-Whitney U test.

Data are expressed as n (%), mean ± SD, and median (minimum:maximum). ASA: American Society of Anesthesiologists; CT: Computed tomography; BMI: Body mass index; PCI: Pelvic cavity index.

Table 5 Comparison of surgical outcomes according to operation type

	n	Open low anterior	n	Laparoscopic low anterior	n	Miles	P value
Operation time (min)	36	240 (165:360)	36	210 (130:360)	6	270 (180:360)	0.023^c
Length of hospital stay (days)	36	9.50 (5:32)	37	7 (4:32)	6	9 (6:19)	< 0.001^c
Readmission
Present	33	7 (21.21)	35	6 (17.14)	6	2 (33.33)	0.684^b
Absent	33	26 (78.79)	35	29 (82.86)	6	4 (66.67)	0.684^b
Dissected lymph nodes	34	15 (1:29)	34	12 (2:42)	6	20 (2:30)	0.389^c
Pelvic infection
Present	36	7 (19.44)	37	3 (8.11)	6	0	0.308^b
Absent	36	29 (80.56)	37	34 (91.89)	6	6 (100)	0.308^b
Local recurrence	34	6 (17.60)	35	9 (25.70)	6	0	0.378^a
Anastomotic leakage	33	5 (15.15)	36	3 (8.33)	0	0	0.527^a
Surgical morbidity	36	15 (41.67)	37	11 (29.73)	1	1 (16.67)
Surgical mortality	36	3 (8.33)	37	2 (5.41)	6	0	0.783^a

^aFisher-Freeman-Halton test.

^bFisher's exact χ² test.

^cKruskal-Wallis test.

Data are expressed as n (%) and median (minimum:maximum).

Table 6 Demographic, pathological, clinical, and radiological comparisons based on local recurrence development

	n	Exist	n	None	P value
Age	15	70.13 ± 10.02	60	64.90 ± 12.29	0.132^a
Gender
Male	15	9 (60)	60	41 (68.33)	0.540^b
Female	15	6 (40)	60	19 (31.67)	0.540^b
BMI (kg/m²)	14	25.40 (19:37.70)	56	25.60 (19.50:44)	0.959^d
Tumor localization
Upper rectum	15	5 (33.33)	60	23 (38.33)	0.768^b
Middle rectum		4 (26.67)		11 (18.33)
Lower rectum		6 (40)		26 (43.33)
ASA score
I	15	0	59	1 (1.69)	0.339^c
II		6 (40)		22 (37.29)
III		8 (53.33)		36 (61.02)
IV		1 (6.67)		0
Tumor stage
0	15	2 (13.33)	59	3 (5.08)	0.720^c
1		4 (26.67)		16 (27.12)
2A		3 (20)		13 (22.03)
2B		0		3 (5.08)
3A		2 (13.33)		11 (18.64)
3B		3 (20)		5 (8.47)
3C		1 (6.67)		8 (13.56)
Tumor size (cm)	15	3 (0.04:8.40)	58	4 (0:17)	0.612^d
Pelvic inlet area-CT (mm²)	15	8476.85 ± 1134.93	59	8431.43 ± 1292.23	0.901^a
Number of dissected lymph nodes (n)	15	12.33 ± 4.97	58	15.10 ± 8.67	0.240^a
PCI	11	10.50 ± 2.54	40	10.41 ± 1.87	0.915^a

^aIndependent samples t-test.

^bχ² test.

^cFisher-Freeman-Halton test.

^dMann-Whitney U test.

Data are expressed as n (%), mean ± SD, and median (minimum:maximum). ASA: American Society of Anesthesiologists; CT: Computed tomography; BMI: Body mass index; PCI: Pelvic cavity index.

Table 7 Risk factors affecting perioperative surgical morbidity, regression analysis

	Univariate logistic regression model		Multivariate logistic regression model
	OR (95%CI)	P value	OR (95%CI)	P value
Age (years)	1.07 (1.02-1.12)	0.005
Gender (male)	3.90 (1.18-12.90)	0.026
BMI	1.05 (0.94-1.16)	0.402
Tumor localization (upper rectum)		0.592
Middle rectum	0.50 (0.13-1.92)	0.313
Lower rectum	0.75 (0.27-2.10)	0.583
ASA score	1.15 (0.48-2.76)	0.747
Operation type (open low anterior)		0.375
Laparoscopic low anterior	0.59 (0.23-1.56)	0.289
Miles	0.28 (0.03-2.65)	0.267
Operation duration	1 (0.99-1.01)	0.637
Blood loss (cc)	1 (0.99-1.02)	0.325
Tumor stage (0)		0.993
1	1.33 (0.14-12.82)	0.803
2A	1.23 (0.24-6.36)	0.804
2B	1.09 (0.20-6.01)	0.920
3A	0	0.999
3B	1.11 (0.19-6.49)	0.907
3C	0.57 (0.07-4.64)	0.601
Tumor size	1.10 (0.91-1.33)	0.311
Pelvic inlet area-CT (mm²)	1 (1-1)	0.913
Amount of dissected lymph node	0.970 (0.91-1.03)	0.348
PCI	0.71 (0.52-1.01)	0.056

For the gender variable, the 'female' category; for tumor localization, the 'upper rectum' category; for the type of operation, the 'open low anterior' category; for tumor stage, the 'stage 0' category; for fecal diversion, the 'present' category; for readmission, the 'absent' category; and for pelvic infection, the 'present' category were considered as the reference categories. ASA: American Society of Anesthesiologists; CT: Computed tomography; BMI: Body mass index; PCI: Pelvic cavity index.

Table 8 Risk factors affecting early recurrence development, regression analysis

	Univariate logistic regression model		Multivariate logistic regression model
	OR (95%CI)	P value	OR (95%CI)	P value
Age (years)	1.04 (0.99-1.09)	0.134
Gender (male)	1.44 (0.45-4.62)	0.542
BMI	0.99 (0.87-1.12)	0.854
Tumor localization (upper rectum)		0.770
Middle rectum	1.67 (0.37-7.48)	0.501
Lower rectum	1.06 (0.29-3.95)	0.929
ASA score	1.29 (0.44-3.78)	0.639
Operation type (open low anterior)		0.721
Laparoscopic low anterior	1.62 (0.51-55.17)	0.419
Miles	0	0.999
Operation duration	0.99 (0.98-1)	0.067	0.99 (0.97-0.99)	0.039
Blood loss (cc)	1 (0.99-1.02)	0.548
Tumor stage (0)		0.807
1	5.33 (0.34-82.83)	0.232
2A	2 (0.19-20.97)	0.563
2B	1.85 (0.16-20.94)	0.621
3A	0	0.999
3B	1.46 (0.11-18.96)	0.775
3C	4.80 (0.39-59.90)	0.223
Tumor size	0.94 (0.74-1.20)	0.635
Pelvic inlet area-CT (mm²)	1 (1-1)	0.900
Amount of dissected lymph node	0.95 (0.88-1.03)	0.239
PCI	1.02 (0.732-1.43)	0.894
Length of stay	1.03 (0.94-1.12)	0.503
Re-admission (exist)	3.63 (1.04-12.72)	0.044	6.07 (1.42-25.97)	0.015
Pelvic infection (exist)	2.25 (0.49-10.29)	0.296

For the gender variable, the 'male' category; for tumor localization, the 'upper rectum' category; for the type of operation, the 'open Low anterior' category; for tumor stage, the 'stage 0' category; for readmission, the 'absent' category; and for pelvic infection, the 'absent' category were considered as the reference categories. ASA: American Society of Anesthesiologists; CT: Computed tomography; BMI: Body mass index; PCI: Pelvic cavity index.

Citation: Ay OF, Firat D, Özçetin B, Ocakoglu G, Ozcan SGG, Bakır Ş, Ocak B, Taşkin AK. Role of pelvimetry in predicting surgical outcomes and morbidity in rectal cancer surgery: A retrospective analysis. World J Gastrointest Surg 2025; 17(4): 104726
URL: https://www.wjgnet.com/1948-9366/full/v17/i4/104726.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i4.104726