TP7.2.5 Surgeon measured radiological pelvic measurements as a patient selection tool for laparoscopic rectal resection – an aide in early learning curve

Abstract

Abstract Introduction Rectal resections are considered one of the most technically demanding laparoscopic procedures. This study reviews one unit’s rectal cancer resections to determine whether pelvic dimensions measured by the surgeon could aide patient selection for laparoscopic resections. Methods A prospectively maintained database was used to identify rectal cancer resections between April 2015 to March 2018 and patient demographics, BMI, height of tumour and operative details were in extracted. Anteroposterior (Coccygio-pubic) and transverse (interspinous) distance were measured retrospectively on linked Axial & Saggital views on staging CT scans. Tumour dimensions in the respective planes were recorded and relative proportions of tumour to pelvic dimensions calculated. These were correlated to operative approach. Results Our cohort comprised of 70 patients (42 men) with a median BMI of 27 and mean age of 71. While 6 operations were planned as open procedures, 64 were attempted laparoscopically. Of these, 55 were completed laparoscopically and 9 were converted (16%). There was no correlation between gender and operative approach (p = 0.2). Mean BMI for laparoscopic group 28.7 and converted group 30.0 which was not statistically significant (p = 0.32). Conversion was more likely for low tumours (89%). Median tumour to pelvic area proportion was 0.14 laparoscopic compared to 0.03 for open and 0.03 for converted suggesting that bulkier tumours are more likely to need conversion. Discussion None of previously identified factors such as gender and BMI predicted conversion in our cohort individually. Tumour size relative to pelvic dimensions is a simple measure a surgeon could use to guide patient selection.