Better operative outcomes achieved with the prone jackknife vs. lithotomy position during abdominoperineal resection in patients with low rectal cancer

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• 作者：Peng Liu ; Haidong Bao ; Xianbin Zhang ; Jian Zhang…
• 关键词：Rectal cancer ; Abdominoperineal resection ; Lithotomy position ; Prone jackknife position
• 刊名：World Journal of Surgical Oncology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：13
• 期：1
• 全文大小：790 KB
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• 刊物主题：Surgical Oncology;
• 出版者：BioMed Central
• ISSN：1477-7819

文摘

Background Lithotomy (LT) and prone jackknife positions (PJ) are routinely used for abdominoperineal resection (APR). The present study compared the clinical, pathological, and oncological outcomes of PJ-APR vs. LT-APR in low rectal cancer patients in order to confirm which position will provide more benefits to patients undergoing APR. Methods This is a retrospective study of consecutive patients with low rectal cancer who underwent curative APR between January 2002 and December 2011. Patients were matched 1:2 (PJ-APR--4 and LT-APR--7 patients) based on gender and age. Perioperative data, postoperative outcomes, and survival were compared between the two approaches. Results Hospital stay was shorter with PJ-APR compared with LT-APR (P--.05). Compared with LT-APR, duration of anesthesia (234?±-0.8 vs. 291?±-9?min, P--.022) and surgery (183?±-4.8 vs. 234?±-0?min, P--.016) was shorter with PJ-APR, and estimated blood losses were smaller (549?±-18 vs. 674?±-50?mL, P--.001). Blood transfusions were required in 37.8% of LT-APR patients and in 8.1% of PJ-APR patients (P--.001). There was no difference in the distribution of N stages (P--.27). Median follow-up was 47.1 (13.6-29.7) months. Postoperative complications were reported by fewer patients after PJ-APR compared with LT-APR (14.9% vs. 32.4%, P--.030). There were no significant differences in overall survival, disease-free survival, local recurrence, and distant metastasis (P--.05). Conclusions The PJ position provided a better exposure for low rectal cancer and had a lower operative risk and complication rates than LT-APR. However, there was no difference in rectal cancer prognosis between the two approaches. PJ-APR might be a better choice for patients with low rectal cancer.