Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
A systematic review and meta-analysis of preoperative MRI-based pelvimetry in predicting surgical difficulty in rectal cancer: Implications for personalised surgical planning
By Kitaguchi D, Kolbinger FR, Dipanjyoti P and 4 others.
Abstract
Background
Magnetic resonance imaging (MRI)-based pelvimetry has been investigated for predicting surgical difficulty in total mesorectal excision (TME) for rectal cancer. However, heterogeneity in pelvimetric parameters, surrogate outcomes, and study design has resulted in inconsistent evidence. This systematic review aimed to synthesise the evidence on commonly used MRI parameters and difficulty surrogates and assess their methodological robustness and clinical relevance.
Methods
PubMed, Embase, and the Cochrane Library were systematically searched through December 2025 for studies evaluating preoperative MRI pelvimetry in patients undergoing TME for rectal cancer. Outcome parameters were surrogate measures of surgical difficulty, including operating time, intraoperative blood loss, conversion to open surgery, pathological quality metrics, and postoperative complications. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool. This systematic review and meta-analysis was reported in accordance with the PRISMA 2020 statement and prospectively registered (PROSPERO: CRD420261287153).