To Study The Operative Outcomes Achieved With The Prone Jackknife During Abdominoperineal Resection In Patients With Low Rectal Cancer

Objective: Prone jackknife(PJ) and Lithotomy(LT) 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. Because the number of patients was higher in the PJ-APR group(n = 192) than in the LT-APR group(n = 37),1:2 matching of eligible patients was performed based on gender and age. Matching was done to decrease the possible bias due to the difference in the number of patients between the groups. Perioperative data, postoperative outcomes, and survival were compared between the two approaches. Statistical analysis was performed using SPSS 16. Chi-square or Fisher’s exact tests, t-tests, Kaplan-Meier curves and log-rank tests, Cox regression were used to analysis the data. P< 0.05 was considered statistically significant.Results: Based on the exclusion criteria and inclusion criteria, 229 patients with primary rectal cancer were included. Among them, 192(83.8%) underwent PJ-APR and 37(16.2%) underwent LT-APR; 147 were men, and 82 were women. Median age was 65 years(range: 28 to 86). After matching, there were 37 patients in the LT-APR group and 74 patients in the PJ-APR group. Besides the matching criteria, there were no differences in TNM stage, postoperative chemo- and radiotherapy, histological grade, pathological type, body mass index, tumor stage, and duration of liquid and semi-liquid diets between the two groups(all P > 0.05). 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.