P-340 Value of Pelvic Index for prediction of anastomotic leakage after laparoscopic low anterior resection in male rectal cancer

Abstract

Introduction: This study aims to digitalize the difficulty for operating of rectal cancer in male narrow pelvic cases by establishing a new index obtained from preoperative MRI imaging. Methods: We studied 43 consecutive male patients who underwent laparoscopic low anterior resection with double-stapling technique (DST) anastomosis for rectal cancer between July 2007 and January 2013. The relation ship between postoperative morbidity including anastomotic leakage and the following the independent variables were analyzed: age, body mass index (BMI), ASA, CEA, number of the underlying diseases, operating time, amount of bleeding, depth of invasion, nodal metastasis, tumor diameter, final Stage by Japanese Classification of Colorectal Carcinoma, eleven parameters measured from preoperative MRI imaging of pelvis, and a new index that is calculated from these several parameters. Eleven parameters are as follows: a = inlet of cavity of lesser pelvis, b = depth of cavity of lesser pelvis, c = diameter of mesorectum, d = thickness of mesorectum, e = transverse diameter of lower rectum, f = longitudinal diameter of lower rectum, g = pelvic inlet, h = pelvic outlet, i = length of sacrum, j= interspinous distance, k= intertuberous distance. The dependent variables were overall postoperative morbidity, and anastomotic leakage. Univariate and multivariate analyses were performed. Moreover we studied whether the new index that was calculated from some parameters would be useful as the predictor for morbidity. Results: CEA (p = 0.0214), nodal metastasis (p = 0.0453), parameter "c" (p = 0.0488) showed the significant difference by univariate analysis. Moreover parameter 'j-c' in leakage -negative group was significantly lower than that in leakage-positive group (p = 0.0488). 100* ('j-c')/'b' that was called pelvic index (P.I) in anastomotic leakage-positive group was significantly smaller than that in anastomotic-negative group. Conclusion: Preoperative measurement with pelvic MRI and calculation of P.I. could predict the narrow pelvis, and contribute risk avoidance.