The Estimate of the Impact of Coccyx Resection in Surgical Field Exposure During Abdominal Perineal Resection Using Preoperative High-Resolution Magnetic Resonance

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art_JULIAO_The_Estimate_of_the_Impact_of_Coccyx_Resection_2018.PDF (759.3 KB)
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0
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article
Data de publicação
2018
DOI
Scopus
Web of Science
PubMed
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SPRINGER
Autores
JULIAO, Guilherme Pagin Sao
VAILATI, Bruna Borba
ROSSI, Gustavo
FERNANDEZ, Laura Melina
BROWN, Gina
Citação
WORLD JOURNAL OF SURGERY, v.42, n.11, p.3765-3770, 2018
Projetos de Pesquisa
Unidades Organizacionais
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Resumo
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.
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https://observatorio.fm.usp.br/handle/OPI/29580
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MPT
Artigos e Materiais de Revistas Científicas - FM/MGT
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InRad
Artigos e Materiais de Revistas Científicas - LIM/01
Artigos e Materiais de Revistas Científicas - LIM/35
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