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Published in: Journal of Gastrointestinal Surgery 3/2015

01-03-2015 | Original Article

Therapeutic Results of Abdominoperineal Resection in the Prone Jackknife Position for T3–4 Low Rectal Cancers

Authors: Xiang Hu, Liang Cao, Jian Zhang, Pin Liang, Ge Liu

Published in: Journal of Gastrointestinal Surgery | Issue 3/2015

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Abstract

Objective

To evaluate the therapeutic results of abdominoperineal resections in the prone jackknife position for T3–4 low rectal cancers.

Methods

From January 2002 to January 2011, 536 patients with T3–T4 low rectal cancer underwent abdominoperineal resection. Two hundred forty-three were treated in the Lloyd-Davies position and 293 in the prone jackknife position. Clinicopathological data and survival of the two groups were analyzed retrospectively.

Results

Abdominoperineal resections in the prone jackknife position group were associated with significantly less blood loss (124 ± 50.68 vs 210.67 ± 83.32 ml, P < 0.001) and shorter operation times (3.10 ± 1.08 vs 3.82 ± 1.43 h, p = 0.010) than those in Lloyd-Davies position group. The total local recurrence rate is 8.4 % (45/536). The local recurrence rate in the prone jackknife position group was significantly lower than in the Lloyd-Davies position group (5.5 vs 11.9 %, P < 0.001). By multivariate regression analysis, depth of tumor invasion (P = 0.032), CRM (P < 0.001), and position (P = 0.015) were found to be independent risk factors for local recurrence. Multivariate Cox regression survival analysis, lymph node metastasis, and CRM (P < 0.001) were proven to be the major independent prognostic factors for T3–T4 low rectal cancer patients.

Conclusions

Abdominoperineal resection in the prone jackknife position for T3–T4 low rectal cancers is feasible and has a lower local recurrence.
Literature
1.
go back to reference MILES W. A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet 1908;2:1812–1813.CrossRef MILES W. A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet 1908;2:1812–1813.CrossRef
2.
go back to reference OV L-D. Lithotomy-Trendelenburg position for resection of the rectum and lower pelvis colon. Lancet 1939; 234: 74–76.CrossRef OV L-D. Lithotomy-Trendelenburg position for resection of the rectum and lower pelvis colon. Lancet 1939; 234: 74–76.CrossRef
3.
go back to reference Bebenek M. Abdominosacral amputation of the rectum for low rectal cancers: ten years of experience. Ann Surg Oncol 2009;16:2211–2217.CrossRefPubMed Bebenek M. Abdominosacral amputation of the rectum for low rectal cancers: ten years of experience. Ann Surg Oncol 2009;16:2211–2217.CrossRefPubMed
4.
go back to reference West NP, Anderin C, Smith KJ, Holm T, Quirke P and European Extralevator Abdominoperineal Excision Study G. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 2010;97:588–599.CrossRefPubMed West NP, Anderin C, Smith KJ, Holm T, Quirke P and European Extralevator Abdominoperineal Excision Study G. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 2010;97:588–599.CrossRefPubMed
5.
go back to reference Tayyab M, Sharma A, Ragg JL, Macdonald AW, Gunn J, Hartley JE and Monson JR. Evaluation of the impact of implementing the prone jackknife position for the perineal phase of abdominoperineal excision of the rectum. Dis Colon Rectum 2012;55:316–321.CrossRefPubMed Tayyab M, Sharma A, Ragg JL, Macdonald AW, Gunn J, Hartley JE and Monson JR. Evaluation of the impact of implementing the prone jackknife position for the perineal phase of abdominoperineal excision of the rectum. Dis Colon Rectum 2012;55:316–321.CrossRefPubMed
6.
go back to reference de Campos-Lobato LF, Stocchi L, Dietz DW, Lavery IC, Fazio VW and Kalady MF. Prone or lithotomy positioning during an abdominoperineal resection for rectal cancer results in comparable oncologic outcomes. Dis Colon Rectum 2011;54:939–946.CrossRefPubMed de Campos-Lobato LF, Stocchi L, Dietz DW, Lavery IC, Fazio VW and Kalady MF. Prone or lithotomy positioning during an abdominoperineal resection for rectal cancer results in comparable oncologic outcomes. Dis Colon Rectum 2011;54:939–946.CrossRefPubMed
7.
go back to reference Martijnse IS, Dudink RL, West NP, Wasowicz D, Nieuwenhuijzen GA, van Lijnschoten I, Martijn H, Lemmens VE, van de Velde CJ, Nagtegaal ID, Quirke P and Rutten HJ. Focus on extralevator perineal dissection in supine position for low rectal cancer has led to better quality of surgery and oncologic outcome. Ann Surg Oncol 2012;19:786–793.CrossRefPubMed Martijnse IS, Dudink RL, West NP, Wasowicz D, Nieuwenhuijzen GA, van Lijnschoten I, Martijn H, Lemmens VE, van de Velde CJ, Nagtegaal ID, Quirke P and Rutten HJ. Focus on extralevator perineal dissection in supine position for low rectal cancer has led to better quality of surgery and oncologic outcome. Ann Surg Oncol 2012;19:786–793.CrossRefPubMed
8.
go back to reference Keller DS, Lawrence JK and Delaney CP. Prone jackknife position is not necessary to achieve a cylindrical abdominoperineal resection: demonstration of the lithotomy position. Dis Colon Rectum 2014;57:251.CrossRefPubMed Keller DS, Lawrence JK and Delaney CP. Prone jackknife position is not necessary to achieve a cylindrical abdominoperineal resection: demonstration of the lithotomy position. Dis Colon Rectum 2014;57:251.CrossRefPubMed
9.
go back to reference Quirke P, Durdey P, Dixon MF and Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2:996–999.CrossRefPubMed Quirke P, Durdey P, Dixon MF and Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2:996–999.CrossRefPubMed
10.
go back to reference How P, Shihab O, Tekkis P, Brown G, Quirke P, Heald R and Moran B. A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol 2011;20:e149–155.CrossRefPubMed How P, Shihab O, Tekkis P, Brown G, Quirke P, Heald R and Moran B. A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol 2011;20:e149–155.CrossRefPubMed
11.
go back to reference K L. Die sacro-abdominale mastdarm-exstirpation. Chirurg 1941;13:511–517. K L. Die sacro-abdominale mastdarm-exstirpation. Chirurg 1941;13:511–517.
12.
go back to reference KH B. Uber die sacro-abdominelle rectum exstirpation. Chirurg 1952;23:145–150. KH B. Uber die sacro-abdominelle rectum exstirpation. Chirurg 1952;23:145–150.
13.
go back to reference Holm T, Ljung A, Haggmark T, Jurell G and Lagergren J. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 2007;94:232–238.CrossRefPubMed Holm T, Ljung A, Haggmark T, Jurell G and Lagergren J. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 2007;94:232–238.CrossRefPubMed
14.
go back to reference den Dulk M, Putter H, Collette L, Marijnen CA, Folkesson J, Bosset JF, Rodel C, Bujko K, Pahlman L and van de Velde CJ. The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer 2009;45:1175–1183.CrossRef den Dulk M, Putter H, Collette L, Marijnen CA, Folkesson J, Bosset JF, Rodel C, Bujko K, Pahlman L and van de Velde CJ. The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer 2009;45:1175–1183.CrossRef
15.
go back to reference Han JG, Wang ZJ, Wei GH, Gao ZG, Yang Y and Zhao BC. Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer. Am J Surg 2012;204:274–282.CrossRefPubMed Han JG, Wang ZJ, Wei GH, Gao ZG, Yang Y and Zhao BC. Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer. Am J Surg 2012;204:274–282.CrossRefPubMed
16.
go back to reference Stelzner S, Hellmich G, Schubert C, Puffer E, Haroske G and Witzigmann H. Short-term outcome of extra-levator abdominoperineal excision for rectal cancer. Int J Colorectal Dis 2011;26:919–925.CrossRefPubMed Stelzner S, Hellmich G, Schubert C, Puffer E, Haroske G and Witzigmann H. Short-term outcome of extra-levator abdominoperineal excision for rectal cancer. Int J Colorectal Dis 2011;26:919–925.CrossRefPubMed
17.
go back to reference Raftopoulos I, Reed JF, 3rd and Bergamaschi R. Circumferential resection margin involvement after laparoscopic abdominoperineal excision for rectal cancer. Colorectal Dis 2012;14:431–437.CrossRefPubMed Raftopoulos I, Reed JF, 3rd and Bergamaschi R. Circumferential resection margin involvement after laparoscopic abdominoperineal excision for rectal cancer. Colorectal Dis 2012;14:431–437.CrossRefPubMed
18.
go back to reference Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R and German Rectal Cancer Study G. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–1740.CrossRefPubMed Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R and German Rectal Cancer Study G. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–1740.CrossRefPubMed
19.
go back to reference Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS, Bessell E, Griffiths G, Thompson LC and Parmar M. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 2009;373:811–820.CrossRefPubMedCentralPubMed Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS, Bessell E, Griffiths G, Thompson LC and Parmar M. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 2009;373:811–820.CrossRefPubMedCentralPubMed
20.
go back to reference Rodel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, Graeven U, Arnold D, Lang-Welzenbach M, Raab HR, Sulberg H, Wittekind C, Potapov S, Staib L, Hess C, Weigang-Kohler K, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R and German Rectal Cancer Study G. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 2012;13:679–687.CrossRefPubMed Rodel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, Graeven U, Arnold D, Lang-Welzenbach M, Raab HR, Sulberg H, Wittekind C, Potapov S, Staib L, Hess C, Weigang-Kohler K, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R and German Rectal Cancer Study G. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 2012;13:679–687.CrossRefPubMed
21.
go back to reference Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T and Rodel C. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 2012;30:1926–1933.CrossRefPubMed Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T and Rodel C. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 2012;30:1926–1933.CrossRefPubMed
22.
go back to reference Tural D, Selcukbiricik F, Yildiz O, Elcin O, Erdamar S, Guney S, Demireli F, Buyukunal E and Serdengecti S. Preoperative versus postoperative chemoradiotherapy in stage T3, N0 rectal cancer. Int J Clin Oncol 2013. Tural D, Selcukbiricik F, Yildiz O, Elcin O, Erdamar S, Guney S, Demireli F, Buyukunal E and Serdengecti S. Preoperative versus postoperative chemoradiotherapy in stage T3, N0 rectal cancer. Int J Clin Oncol 2013.
23.
go back to reference Heald RJ, Husband EM and Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982;69:613–616.CrossRefPubMed Heald RJ, Husband EM and Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982;69:613–616.CrossRefPubMed
24.
go back to reference Stelzner S, Koehler C, Stelzer J, Sims A and Witzigmann H. Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer—a systematic overview. Int J Colorectal Dis 2011;26:1227–1240.CrossRefPubMed Stelzner S, Koehler C, Stelzer J, Sims A and Witzigmann H. Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer—a systematic overview. Int J Colorectal Dis 2011;26:1227–1240.CrossRefPubMed
25.
go back to reference Schiphorst AH, Doeksen A, Hamaker ME, Zimmerman DD and Pronk A. Short-term follow-up after laparoscopic versus conventional total mesorectal excision for low rectal cancer in a large teaching hospital. Int J Colorectal Dis 2014;29:117–125.CrossRefPubMed Schiphorst AH, Doeksen A, Hamaker ME, Zimmerman DD and Pronk A. Short-term follow-up after laparoscopic versus conventional total mesorectal excision for low rectal cancer in a large teaching hospital. Int J Colorectal Dis 2014;29:117–125.CrossRefPubMed
26.
go back to reference Davies M, Harris D, Hirst G, Beynon R, Morgan AR, Carr ND and Beynon J. Local recurrence after abdomino-perineal resection. Colorectal Dis 2009;11:39–43.CrossRefPubMed Davies M, Harris D, Hirst G, Beynon R, Morgan AR, Carr ND and Beynon J. Local recurrence after abdomino-perineal resection. Colorectal Dis 2009;11:39–43.CrossRefPubMed
27.
go back to reference Liang JT, Cheng JC, Huang KC, Lai HS and Sun CT. Comparison of tumor recurrence between laparoscopic total mesorectal excision with sphincter preservation and laparoscopic abdominoperineal resection for low rectal cancer. Surg Endosc 2013;27:3452–3464.CrossRefPubMed Liang JT, Cheng JC, Huang KC, Lai HS and Sun CT. Comparison of tumor recurrence between laparoscopic total mesorectal excision with sphincter preservation and laparoscopic abdominoperineal resection for low rectal cancer. Surg Endosc 2013;27:3452–3464.CrossRefPubMed
28.
go back to reference Chambers W, Khan A, Waters R, Lindsey I, George B, Mortensen N and Cunningham C. Examination of outcome following abdominoperineal resection for adenocarcinoma in Oxford. Colorectal Dis 2010;12:1192–1197.CrossRefPubMed Chambers W, Khan A, Waters R, Lindsey I, George B, Mortensen N and Cunningham C. Examination of outcome following abdominoperineal resection for adenocarcinoma in Oxford. Colorectal Dis 2010;12:1192–1197.CrossRefPubMed
29.
go back to reference Kim JS, Hur H, Kim NK, Kim YW, Cho SY, Kim JY, Min BS, Ahn JB, Keum KC, Kim H, Sohn SK and Cho CH. Oncologic outcomes after radical surgery following preoperative chemoradiotherapy for locally advanced lower rectal cancer: abdominoperineal resection versus sphincter-preserving procedure. Ann Surg Oncol 2009;16:1266–1273.CrossRefPubMed Kim JS, Hur H, Kim NK, Kim YW, Cho SY, Kim JY, Min BS, Ahn JB, Keum KC, Kim H, Sohn SK and Cho CH. Oncologic outcomes after radical surgery following preoperative chemoradiotherapy for locally advanced lower rectal cancer: abdominoperineal resection versus sphincter-preserving procedure. Ann Surg Oncol 2009;16:1266–1273.CrossRefPubMed
Metadata
Title
Therapeutic Results of Abdominoperineal Resection in the Prone Jackknife Position for T3–4 Low Rectal Cancers
Authors
Xiang Hu
Liang Cao
Jian Zhang
Pin Liang
Ge Liu
Publication date
01-03-2015
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 3/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-014-2683-1

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