World Journal of Surgery

, Volume 42, Issue 11, pp 3765–3770 | Cite as

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

  • Guilherme Pagin São Julião
  • Cinthia D. Ortega
  • Bruna Borba Vailati
  • Francisco A. B. Coutinho
  • Gustavo Rossi
  • Angelita Habr-Gama
  • Laura Melina Fernandez
  • Sérgio Eduardo Alonso Araújo
  • Gina Brown
  • Rodrigo Oliva PerezEmail author
Original Scientific Report



To estimate the improvement in surgical exposure by removal of the coccyx, during abdomino-perineal resection (APR), in rectal cancer patients.


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).


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.


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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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Guilherme Pagin São Julião
    • 1
  • Cinthia D. Ortega
    • 2
  • Bruna Borba Vailati
    • 1
  • Francisco A. B. Coutinho
    • 3
  • Gustavo Rossi
    • 4
  • Angelita Habr-Gama
    • 1
    • 5
  • Laura Melina Fernandez
    • 1
  • Sérgio Eduardo Alonso Araújo
    • 6
  • Gina Brown
    • 7
  • Rodrigo Oliva Perez
    • 1
    • 6
    • 8
    Email author
  1. 1.Angelita and Joaquim Gama InstituteSão PauloBrazil
  2. 2.Radiology DepartmentUniversity of São Paulo School of MedicineSão PauloBrazil
  3. 3.Department of PathologyUniversity of São Paulo School of MedicineSão PauloBrazil
  4. 4.Hospital Italiano de Buenos Aires Colorectal Surgery DivisionBuenos AiresArgentina
  5. 5.University of São Paulo School of MedicineSão PauloBrazil
  6. 6.Colorectal Surgery DivisionUniversity of São Paulo School of MedicineSão PauloBrazil
  7. 7.Department of RadiologyThe Royal Marsden NHS Foundation TrustSuttonUK
  8. 8.Ludwig Institute for Cancer Research São Paulo BranchSão PauloBrazil

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