Preoperative Predictive Model of Narrow Pelvis in Laparoscopic Radical Prostatectomy Through Computed Tomography

Objective: At present, prostate cancer radical surgery still lacks an objective standard for predicting the anatomic difficulty of surgery through preoperative examination. Due to the poor prognosis and surgical complications caused by "Narrow Pelvis," a pelvic model for prediction is urgently needed. The purpose of this study is to present objective preoperative assessing indicators to predict the surgical difficulty caused by pelvic anatomic abnormalities during laparoscopic radical prostatectomy (LRP). Methods: Patients undergoing LRP were retrospectively analyzed and separated into "Common Pelvis" or "Difficult Pelvis" groups according to the preset criteria. The clinical data and pelvic imaging data of the two groups were compared to obtain statistically significant differences. The results were compared and validated in 500 ordinary males. Logistic regression analysis was performed to optimize these indicators into a scoring model, "Laparoscopic Radical Prostatectomy Narrow Pelvic Predictive Index (LRP-NPPI)" for predicting "Difficult Pelvis." Results: Of the 145 patients undergoing LRP, 22 (15.2%) were included in the "Difficult Pelvis" group. Patients in the "Difficult Pelvis" group were more likely to have a narrower, shorter, deeper, more flattened pelvis, greater body mass index, more history of previous pelvic surgery, and greater prostate volume. Moreover, the larger amount of intraoperative blood loss and longer operation time were related. Compared with the "Common Pelvis" group, patients in the "Difficult Pelvis" have higher score of LRP-NPPI (p < 0.05). Conclusion: With the model we proposed, it is possible to predict patients with pelvic anatomical difficulties during LRP.