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

Abstract

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=74 and LT-APR=37 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<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). 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.