Guilherme Pagin São Julião1, Cinthia D Ortega2, Bruna Borba Vailati1, Francisco A B Coutinho3, Gustavo Rossi4, Angelita Habr-Gama1,5, Laura Melina Fernandez1, Sérgio Eduardo Alonso Araújo6, Gina Brown7, Rodrigo Oliva Perez8,9,10. 1. Angelita and Joaquim Gama Institute, Rua Manoel da Nóbrega 1564, São Paulo, SP, 04001-005, Brazil. 2. Radiology Department, University of São Paulo School of Medicine, Travessa da Rua Dr. Ovídio Pires de Campos, 75, São Paulo, SP, 05403-010, Brazil. 3. Department of Pathology, University of São Paulo School of Medicine, Av. Dr. Arnaldo 455, São Paulo, SP, Brazil. 4. Hospital Italiano de Buenos Aires Colorectal Surgery Division, 4190 Perón St., 1199ABB, Buenos Aires, Argentina. 5. University of São Paulo School of Medicine, Rua Manoel da Nóbrega 1564, São Paulo, SP, 04001-005, Brazil. 6. Colorectal Surgery Division, University of São Paulo School of Medicine, Rua Manoel da Nóbrega 1564, São Paulo, SP, 04001-005, Brazil. 7. Department of Radiology, The Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, SM2 5PT, UK. 8. Angelita and Joaquim Gama Institute, Rua Manoel da Nóbrega 1564, São Paulo, SP, 04001-005, Brazil. rodrigo.operez@gmail.com. 9. Colorectal Surgery Division, University of São Paulo School of Medicine, Rua Manoel da Nóbrega 1564, São Paulo, SP, 04001-005, Brazil. rodrigo.operez@gmail.com. 10. Ludwig Institute for Cancer Research São Paulo Branch, Rua Manoel da Nóbrega 1564, São Paulo, SP, 04001-005, Brazil. rodrigo.operez@gmail.com.
Abstract
OBJECTIVE: To estimate the improvement in surgical exposure by removal of the coccyx, during abdomino-perineal resection (APR), in rectal cancer patients. METHODS: Retrospective study of 29 consecutive patients with rectal cancer was carried out. Using MR T2 sagittal series, the solid angle was estimated using the angle determined by the anterior resection margin and the tip of coccyx (no coccyx resection) or the tip of last sacral vertebra (coccyx resection). The solid angle provides an estimate of the tridimensional surface area provided by an original angle resulting in the best estimate of the surgeon's view/exposure to the critical dissecting point of choice (anterior rectal wall). The difference ("Gain") in surgical field exposure by removal of the coccyx was compared by the solid angle variation between the two estimates (with and without the coccyx). RESULTS: Routine removal of the coccyx determines an average 42% (95% CI 27-57%) gain in surgical field exposure area facing the anterior rectal wall at the level of the prostate/vagina by the surgeon. Fifteen (51%) patients had ≥30% (median) estimated gain in surgical field exposure by coccygectomy. There was no association between BMI, age or gender and estimated gain in surgical field exposure area. CONCLUSIONS: Routine removal of the coccyx during APR may result in an average increase in 42% in surgical field exposure during APR's perineal dissection. Precise estimation of surgical field exposure gain by removal of the coccyx may be predicted by MR sagittal series for each individual patient.
OBJECTIVE: To estimate the improvement in surgical exposure by removal of the coccyx, during abdomino-perineal resection (APR), in rectal cancerpatients. METHODS: Retrospective study of 29 consecutive patients with rectal cancer was carried out. Using MR T2 sagittal series, the solid angle was estimated using the angle determined by the anterior resection margin and the tip of coccyx (no coccyx resection) or the tip of last sacral vertebra (coccyx resection). The solid angle provides an estimate of the tridimensional surface area provided by an original angle resulting in the best estimate of the surgeon's view/exposure to the critical dissecting point of choice (anterior rectal wall). The difference ("Gain") in surgical field exposure by removal of the coccyx was compared by the solid angle variation between the two estimates (with and without the coccyx). RESULTS: Routine removal of the coccyx determines an average 42% (95% CI 27-57%) gain in surgical field exposure area facing the anterior rectal wall at the level of the prostate/vagina by the surgeon. Fifteen (51%) patients had ≥30% (median) estimated gain in surgical field exposure by coccygectomy. There was no association between BMI, age or gender and estimated gain in surgical field exposure area. CONCLUSIONS: Routine removal of the coccyx during APR may result in an average increase in 42% in surgical field exposure during APR's perineal dissection. Precise estimation of surgical field exposure gain by removal of the coccyx may be predicted by MR sagittal series for each individual patient.
Authors: Angelita Habr-Gama; Guilherme P São Julião; Adrian Mattacheo; Luiz Felipe de Campos-Lobato; Edgar Aleman; Bruna B Vailati; Joaquim Gama-Rodrigues; Rodrigo Oliva Perez Journal: World J Surg Date: 2017-08 Impact factor: 3.352
Authors: Iris D Nagtegaal; Cornelius J H van de Velde; Corrie A M Marijnen; Jan H J M van Krieken; Philip Quirke Journal: J Clin Oncol Date: 2005-12-20 Impact factor: 44.544
Authors: Luiz Felipe de Campos-Lobato; Luca Stocchi; David W Dietz; Ian C Lavery; Victor W Fazio; Matthew F Kalady Journal: Dis Colon Rectum Date: 2011-08 Impact factor: 4.585
Authors: Fiona G M Taylor; Philip Quirke; Richard J Heald; Brendan Moran; Lennart Blomqvist; Ian Swift; David J Sebag-Montefiore; Paris Tekkis; Gina Brown Journal: Ann Surg Date: 2011-04 Impact factor: 12.969
Authors: G P São Julião; C D Ortega; B B Vailati; A Habr-Gama; L M Fernandez; J Gama-Rodrigues; S E Araujo; R O Perez Journal: Colorectal Dis Date: 2017-06 Impact factor: 3.788