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 [DOI: 10.4240/wjgs.v17.i4.104726]
Corresponding Author of This Article
Oguzhan Fatih Ay, MD, Department of General Surgery, Kahramanmaras Necip Fazıl City Hospital, Gaziantep Yolu 12, Kahramanmaras 46140, Türkiye. droguzhanf.ay@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2025; 17(4): 104726 Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.104726
Role of pelvimetry in predicting surgical outcomes and morbidity in rectal cancer surgery: A retrospective analysis
Oguzhan Fatih Ay, Deniz Firat, Bülent Özçetin, Gokhan Ocakoglu, Seray Gizem Gur Ozcan, Şule Bakır, Birol Ocak, Ali Kemal Taşkin
Oguzhan Fatih Ay, Department of General Surgery, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras 46140, Türkiye
Deniz Firat, Bülent Özçetin, Ali Kemal Taşkin, Department of General Surgery, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa 16110, Türkiye
Gokhan Ocakoglu, Department of Biostatistics, Uludag University Faculty of Medicine, Bursa 16059, Türkiye
Seray Gizem Gur Ozcan, Department of Radiology, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa 16110, Türkiye
Şule Bakır, Department of Pathology, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa 16110, Türkiye
Birol Ocak, Department of Medical Oncology, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa 16110, Türkiye
Author contributions: Ay OF and Firat D conceptualized the study and drafted the manuscript; Özçetin B, Ozcan SGG, Bakır Ş, Ocak B and Taşkin AK collected data, whereas Ocakoglu G conducted the analysis; all the authors critically revised the manuscript to ensure that it contained significant intellectual content; the final manuscript has been read and approved by all authors; all authors have been sufficiently involved in the project and consented to being held accountable for all aspects.
Institutional review board statement: The Ethics Committee of the SBU Bursa Yuksek Ihtisas Research and Training Hospital provided its approval for our clinical research on 10.08.2022 with the decision number is 2011-KAEK–25 2022/08–02. This study adhered to the principles of the Declaration of Helsinki.
Informed consent statement: The patients who participated in the study were informed that their data could be used in academic and scientific procedures upon hospital admission. Consent was obtained from all participants.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Data sharing statement: If the requesting individual contacted the corresponding author via email, the datasets used in our study, with the exception of the personal private data of the patients, could be shared.
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: Oguzhan Fatih Ay, MD, Department of General Surgery, Kahramanmaras Necip Fazıl City Hospital, Gaziantep Yolu 12, Kahramanmaras 46140, Türkiye. droguzhanf.ay@gmail.com
Received: December 31, 2024 Revised: January 28, 2025 Accepted: February 27, 2025 Published online: April 27, 2025 Processing time: 89 Days and 13.7 Hours
Abstract
BACKGROUND
Rectal cancer has increased in incidence, and surgery remains the cornerstone of multimodal treatment. Pelvic anatomy, particularly a narrow pelvis, poses challenges in rectal cancer surgery, potentially affecting oncological outcomes and postoperative complications.
AIM
To investigate the relationship between radiologically assessed pelvic anatomy and surgical outcomes as well as the impact on local recurrence following rectal cancer surgery.
METHODS
We retrospectively analyzed 107 patients with rectal adenocarcinoma treated with elective rectal surgery between January 1, 2017, and September 1, 2022. Pelvimetric measurements were performed using computed tomography (CT)-based two-dimensional methods (n = 77) by assessing the pelvic inlet area in mm², and magnetic resonance imaging (MRI)-based three-dimensional techniques (n = 52) using the pelvic cavity index (PCI). Patient demographic, clinical, radiological, surgical, and pathological characteristics were collected and analyzed in relation to their pelvimetric data.
RESULTS
When patients were categorized based on CT measurements into narrow and normal/wide pelvis groups, a significant association was observed with male sex, and a lower BMI was more common in the narrow pelvis group (P = 0.002 for both). A significant association was found between a narrow pelvic structure, indicated by low PCI, and increased surgical morbidity (P = 0.049). Advanced age (P = 0.003) and male sex (P = 0.020) were significantly correlated with higher surgical morbidity. Logistic regression analysis identified four parameters that were significantly correlated with local recurrence: older age, early perioperative readmission, longer operation time, and a lower number of dissected lymph nodes (P < 0.05). However, there were no significant differences between the narrow and normal/wide pelvis groups in terms of the operation time, estimated blood loss, or overall local recurrence rate (P > 0.05).
CONCLUSION
MRI-based pelvimetry may be valuable in predicting surgical difficulty and morbidity in rectal cancer surgery, as indicated by the PCI. The observed correlation between low PCI and increased surgical morbidity suggests the potential importance of a preoperative MRI-based pelvimetric evaluation. In contrast, CT-based pelvimetry did not show significant differences in predicting surgical outcomes or cancer recurrence, indicating that the utility of pelvimetry alone may be limited in these respects.
Core Tip: This study investigates the role of pelvimetry in predicting surgical and oncological outcomes in rectal cancer patients. Using computed tomography (CT)-based pelvic inlet area measurements and magnetic resonance imaging-based pelvic cavity index (PCI), the study identifies lower PCI as a significant predictor of surgical morbidity. However, CT-based pelvimetry showed no significant correlation with operation time or local recurrence. Multivariate analysis highlights age, sex, and PCI as independent risk factors for morbidity. While pelvimetry is useful for assessing surgical complexity, its value in predicting oncological outcomes remains limited, warranting further validation through larger multicenter studies.
