title: Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer.
abstract: BACKGROUND
  An alternative treatment for low rectal cancer is the cylindrical technique. We aim to compare the outcomes of patients undergoing conventional abdominoperineal resection (APR) versus cylindrical APR.
  
  
  METHODS
  A prospective, randomized, open-label, parallel controlled trial was conducted between January 2008 and December 2010. Sixty-seven patients with T3-T4 low rectal cancer were identified during the study period (conventional n = 32, cylindrical n = 35).
  
  
  RESULTS
  Patients who received cylindrical APR had less operative time for the perineal portion (P < .001), larger perineal defect (P < .001), less intraoperative blood loss (P = .001), larger total cross-sectional tissue area (P < .001), similar total operative time (P = .096), and more incidence of perineal pain (P < .001). The local recurrence of the cylindrical APR group was improved statistically (P = .048).
  
  
  CONCLUSIONS
  Cylindrical APR in the prone jackknife position has the potential to reduce the risk of local recurrence without increased complications when compared with conventional APR in the lithotomy position for the treatment of low rectal cancer.
authors.affiliation: Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Jia Gang
authors.initials: JG
authors.lastname: Han
authors.forename: Zhen Jun
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Guang Hui
authors.initials: GH
authors.lastname: Wei
authors.forename: Zhi Gang
authors.initials: ZG
authors.lastname: Gao
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.forename: Bao Cheng
authors.initials: BC
authors.lastname: Zhao
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D017024:Chemotherapy, Adjuvant; D003113:Colonoscopy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018579:Patient Selection; D010502:Perineum / Q000601:surgery*; D016684:Prone Position; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016683:Supine Position; D016896:Treatment Outcome