Purpose: Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution. Methods: A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx’s tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses. Results: Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape. Conclusion: Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.

3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections / Lorenzon, L.; Bini, F.; Landolfi, F.; Quinzi, S.; Balducci, G.; Marinozzi, F.; Biondi, A.; Persiani, R.; D'Ugo, D.; Tirelli, F.; Iannicelli, E.. - In: INTERNATIONAL JOURNAL OF COLORECTAL DISEASE. - ISSN 0179-1958. - 36:5(2021), pp. 977-986. [10.1007/s00384-020-03802-9]

3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections

Lorenzon L.
;
Bini F.;Landolfi F.;Balducci G.;Marinozzi F.;Iannicelli E.
2021

Abstract

Purpose: Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution. Methods: A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx’s tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses. Results: Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape. Conclusion: Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.
2021
3d imaging; rectal cancer; tatme; total mesorectal excision
01 Pubblicazione su rivista::01a Articolo in rivista
3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections / Lorenzon, L.; Bini, F.; Landolfi, F.; Quinzi, S.; Balducci, G.; Marinozzi, F.; Biondi, A.; Persiani, R.; D'Ugo, D.; Tirelli, F.; Iannicelli, E.. - In: INTERNATIONAL JOURNAL OF COLORECTAL DISEASE. - ISSN 0179-1958. - 36:5(2021), pp. 977-986. [10.1007/s00384-020-03802-9]
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Note: https://doi.org/10.1007/s00384-020-03802-9
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1515499
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