The Application Of BMI Combined With Pelvic Measurement In Laparoscopic Surgery For Low Rectal Cancer

AIM:To explore the application of BMI combined with pelvic measurement in laparoscopic surgery for low rectal cancer.METHODS: A retrospective analysis was performed on 281 patients with middle and low rectal cancer who underwent laparoscopic surgery in the first affiliated hospital of fujian medical university from May 2016 to April 2018.A total of 88 cases were selected as appropriate,Pelvic magnetic resonance and CT scan were used to measure the parameters of pelvic: bispinous diameter,the distance from the sacral blade to the dentate line,the distance from the anterior sacral curve,the anteroposterior diameter of the middle pelvis,and the distance from the tumor to the dentate line.The effects of BMI and the above pelvic measurement parameters on the operative time,blood loss and mesangial integrity of laparoscopic middle and low rectal cancer were analyzed by pairwise analysis,multiple regression analysis and stepwise analysis.RESULTS: Of 281 cases,eliminate intraoperative transfer laparotomy 13 cases.57 cases of clinical data missing or unclear,excluding scoliosis and pelvic deformity patients,4 cases.out of 65 cases of tumor diameter greater than 5 cm.multiple organ resection and miles operation,18 cases.36 cases of neoadjuvant chemotherapy.88 patients into the group standard,42 cases of men,46 cases of women.The correlation between surgical time,blood loss and mesangial integrity,BMI,distance of ischial spine,BMI/TDM(BMI/ Transverse Diameter of Midplane),distance between sacral blade and dentate line,anterior sacral curve distance,curvature ratio,midpelvis anteroposterior diameter and distance between tumor and dentate line was analyzed.The pairwise correlation analysis results showed that: the blood loss was significantly correlated with the BMI/TDM and BMI(P < 0.05),and the BMI/TDM had the lowest P value.The operative time was significantly correlated with BMI,ischial interspinous diameter,BMI/TDM and the distance between tumor and dentate line(P < 0.05).Mesangial integrity was significantly correlated with BMI/TDM and BMI(P < 0.05),and BMI/TDM had the lowest P value.Multiple regression analysis showed that the blood loss was significantly correlated with BMI/TDM(p=0.0002).Operative time was significantly correlated with BMI/TDM(p=4.6e-06)and tumor distance from dentate line(p=0.001);Mesangial integrity was significantly correlated with the BMI/TDM(p=0.0004).Stepwise regression analysis showed that: blood loss was significantly correlated with BMI/TDM(p=7.73e-05);The operative time was significantly correlated with the BMI/TDM(p=2e-06)and the distance between the tumor and dentate line(p=0.00198).Mesangial integrity was significantly correlated with the BMI/TDM(p=0.0003).CONCLUSION: Measuring the BMI/TDM and the distance between the tumor and dentate line can predict the difficulty of laparoscopic surgery for middle and low rectal cancer.Among them,the correlation of BMI/TDM is stronger.For patients with high BMI/TDM,traditional laparoscopic surgery is difficult,so TaTME surgery can be considered.