{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:53:55Z","timestamp":1791269635541,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP256f0137008"],"award-info":[{"award-number":["JP256f0137008"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Magnetic resonance imaging (MRI)\u2010based 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010randomised Studies of Exposures (ROBINS\u2010E) tool. This systematic review and meta\u2010analysis was reported in accordance with the PRISMA 2020 statement and prospectively registered (PROSPERO: CRD420261287153).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010six studies comprising 8,364 patients were included. Common parameters included sagittal measurements and axial interspinous distance (ISD) and intertuberous distance (ITD). Definitions of surgical difficulty varied substantially. ROBINS\u2010E identified some concerns in 30 studies, a high risk of bias in five, and insufficient information in one. Meta\u2010analysis of six studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009769) showed that shorter ISD (mean difference [MD] \u22125.13\u2009mm, 95% CI \u22126.61 to \u22123.65;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%) and ITD (MD \u22127.32\u2009mm, 95% CI \u221210.24 to \u22124.39;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%) were significantly associated with surrogate measures of surgical difficulty.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MRI\u2010based pelvimetry, particularly ISD and ITD, may help predict surgical difficulty in TME. However, methodological heterogeneity limits broader quantitative synthesis and highlights the need for standardised pelvimetric protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70644","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:43:39Z","timestamp":1791269019000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A systematic review and meta\u2010analysis of preoperative\n                    <scp>MRI<\/scp>\n                    \u2010based pelvimetry in predicting surgical difficulty in rectal cancer: Implications for personalised surgical planning"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8197-6317","authenticated-orcid":false,"given":"Daichi","family":"Kitaguchi","sequence":"first","affiliation":[{"name":"Department of Surgery, Institute of Medicine University of Tsukuba  Tsukuba Japan"},{"name":"Research Institute against Digestive Cancer (IRCAD)  Strasbourg France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2265-4809","authenticated-orcid":false,"given":"Fiona R.","family":"Kolbinger","sequence":"additional","affiliation":[{"name":"Weldon School of Biomedical Engineering Purdue University  West Lafayette Indiana USA"},{"name":"Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Dresden TUD Dresden University of Technology  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Dipanjyoti","sequence":"additional","affiliation":[{"name":"Indian Institute of Engineering Science and Technology (IIEST)  Shibpur India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-8335","authenticated-orcid":false,"given":"Kshitij","family":"Jadhav","sequence":"additional","affiliation":[{"name":"Koita Centre for Digital Health Indian Institute of Technology (IIT) Bombay  Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6115-0158","authenticated-orcid":false,"given":"Tatsuya","family":"Oda","sequence":"additional","affiliation":[{"name":"Department of Surgery, Institute of Medicine University of Tsukuba  Tsukuba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2038-8957","authenticated-orcid":false,"given":"Antonello","family":"Forgione","sequence":"additional","affiliation":[{"name":"Research Institute against Digestive Cancer (IRCAD)  Strasbourg France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1400-6230","authenticated-orcid":false,"given":"Jacques","family":"Marescaux","sequence":"additional","affiliation":[{"name":"Research Institute against Digestive Cancer (IRCAD)  Strasbourg France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800691019"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(86)91510\u20102"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(13)70016\u20100"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1414882"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(10)70131\u20105"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(14)70205\u20100"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(21)00094\u20107"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.10529"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003002"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.12009"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003021"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(22)00248\u20105"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.8123"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005523"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.24276"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(21)00079\u20106"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2024.06.019"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(20)30555\u20106"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.00032"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.01208"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2025.05.528"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010020\u201002274\u2010x"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2024.108602"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u201014\u2010135"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280216669183"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10642"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.7219"},{"key":"e_1_2_15_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010015\u20104615\u2010x"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znac324"},{"key":"e_1_2_15_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010014\u20103818\u2010x"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13304\u2010022\u201001429\u20109"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010018\u20106331\u20109"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010024\u201011485\u20104"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v29.i3.536"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering10040468"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.70644","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/codi.70644","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.70644","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:43:40Z","timestamp":1791269020000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.70644"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":37,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/codi.70644"],"URL":"https:\/\/doi.org\/10.1111\/codi.70644","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-06-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70644"}}