Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic‐assisted mesorectal excision and intersphincteric resection respectively in different ways

Abstract

Aim Many studies have demonstrated predictors of the difficulty of laparoscopic anterior resection for rectal cancer. Few studies focus on the influence of pelvic dimensions on robotic-assisted mesorectal excision (ME) and intersphincteric resection (ISR). This study aimed to evaluate the influences of the mesorectal fat area (MFA) and mesorectal area on the difficulty of robotic sphincter-saving surgery. Methods We included 156 patients with middle and low rectal cancer who underwent robotic sphincter-saving surgery. Clinical and anatomical factors, including the pelvic dimensions, were collected. Linear regression was performed for variables associated with surgical duration. We also performed subgroup analyses for robotic-assisted ME and ISR. Logistic regression was used to find variables associated with transanal dissection. Results For patients with middle or low rectal cancer, the sacral length and tumour distance from the anal verge were independently associated with surgical duration. The pT stage, sacral length and the MFA were independent predictors for the surgical duration of robotic-assisted ME. By contrast, a small mesorectal area was independently related to a longer duration of robotic-assisted ISR. The pelvic outlet length was independently associated with the use of transanal dissection for ISR. Conclusion It is suggested that a large MFA could affect the difficulty of ME in robotic-assisted ME, while a small mesorectal area could increase the surgical difficulty of robotic-assisted ISR for low rectal cancer. Besides, the pelvic outlet length was associated with the use of transanal dissection. Further studies are needed to validate the results and draw more scientific conclusions.

The impact of mesorectal fat area on recurrence following total mesorectal excision for lower rectal cancer

“…As for racial differences in MFA, little is known because few studies thus far have evaluated MFA. Two studies conducted in Europe reported mean MFA values of 19.4 cm 2 and 20.7 cm 2 , respectively, which were consistent with our results [1,17]. On the other hand, Bolye et al [14] reported that the mean MFA values in an English population were 25.6 cm 2 in males and 18.4 cm 2 in females, whereas those in our study were 20.6 cm 2 and 16.67 cm 2 , respectively.…”

“…Given the results of the aforementioned study as well as our own, aggressive adjuvant chemotherapy may be recommended to reduce recurrence rates in cases with small MFA. Smaller MFA was associated with higher recurrence rates, while larger MFA was related to increased surgical di culty in rectal cancer [15][16][17]. It is di cult to explain this inconsistency.…”

“…It is considered to be a surrogate for total mesorectal volume. Several previous studies have demonstrated the relationship between a larger MFA and various surgical di culties in patients with rectal cancer, such as longer operative time and higher rate of conversion to open surgery [15][16][17]. However, the relationship between MFA and recurrence remains unclear.…”

Role of Perirectal Fat in the Carcinogenesis and Development of Early-Onset Rectal Cancer

“…Some researchers found that low VAT was a poor prognostic marker because it could lead to impairment in nutritional supply and subsequent malnutrition [ 43 , 44 ]. In addition, higher PFA might affect the surgical difficulty of TME and intersphincteric resection, leading to poor oncological outcomes [ 45 ]. This was consistent with the results of our survival analysis.…”

Radiation-Induced Pelvic Colorectal Obstruction After Neoadjuvant Chemoradiotherapy and Sphincter-Saving Surgery for Rectal Cancer: Is IMRT Better?

“…The de nitions of pelvic parameters measured from MRI before the primary surgery have been described previously, including the pelvic inlet length, the pubic tubercle height, the pelvic outlet length, the sacral length, the sacral depth, the interspinous distance, the mesorectal area and the rectal area [10,11].…”