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

Peng Liu,Peng Gong,Chunyan Li,Li Ma,Xianbin Zhang,Jian Zhang,Zhongyu Wang,Haidong Bao,Yulin Wang

doi:10.1186/s12957-015-0453-5

Abstract

BackgroundLithotomy (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.MethodsThis 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 = 74 and LT-APR = 37 patients) based on gender and age. Perioperative data, postoperative outcomes, and survival were compared between the two approaches.ResultsHospital stay was shorter with PJ-APR compared with LT-APR (P < 0.05). Compared with LT-APR, duration of anesthesia (234 ± 50.8 vs. 291 ± 69 min, P = 0.022) and surgery (183 ± 44.8 vs. 234 ± 60 min, P = 0.016) was shorter with PJ-APR, and estimated blood losses were smaller (549 ± 218 vs. 674 ± 350 mL, P < 0.001). Blood transfusions were required in 37.8% of LT-APR patients and in 8.1% of PJ-APR patients (P < 0.001). There was no difference in the distribution of N stages (P = 0.27). Median follow-up was 47.1 (13.6–129.7) months. Postoperative complications were reported by fewer patients after PJ-APR compared with LT-APR (14.9% vs. 32.4%, P = 0.030). There were no significant differences in overall survival, disease-free survival, local recurrence, and distant metastasis (P > 0.05).ConclusionsThe 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.

Highlights

Lithotomy (LT) and prone jackknife positions (PJ) are routinely used for abdominoperineal resection (APR)
APR was gradually replaced by anterior resection (AR) and low anterior resection (LAR) for tumors of the upper and middle rectum [6]
Patients’ characteristics Between January 2002 and December 2011, 383 patients underwent curative APR for low rectal cancer; 154 patients were excluded from the analysis, and 229 patients with primary rectal cancer were included

Summary

Introduction

Lithotomy (LT) and prone jackknife positions (PJ) are routinely used for abdominoperineal resection (APR). The LT position provides adequate access to the rectovaginal septum and allows easy access to the posterior face of the rectum [10]. This position is uncomfortable for the surgeons and the assistants, blood tends to accumulate in the operation area, and adequate lighting is often challenging. The PJ position is appropriate for almost all proctological surgeries It allows an excellent exposure of the posterior and anal perineum and the anterior face of the rectum, Liu et al World Journal of Surgical Oncology (2015) 13:39 provides a more comfortable position for the surgeon and assistants, results in less blood accumulation, and enables better lighting. Another study has suggested that there might be no difference in perioperative morbidity and oncological outcomes between the PJ and LT positions [14]

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