title: A 12-year experience of the Trendelenburg perineal approach for abdominoperineal resection.
abstract: BACKGROUND
  The abdominoperineal resection (APR) is the current accepted surgical technique for low rectal cancers. Negative circumferential surgical margins are an important prognostic indicator and are best obtained by producing a cylindrical specimen. The 'ideal' approach to produce such specimen is debated between a standard lithotomy position and turning the patient in the prone position in the later stages of the procedure. We aimed to assess results of perineal morbidity and oncological outcomes following the lithotomy approach at a single institution.
  
  
  METHODS
  Data were collected retrospectively at a single institution. All patients undergoing the APR for low rectal cancers were included in the current study. Patients underwent this procedure in the standard lithotomy position and a mucocutaneous flap was not routinely used for closure of the perineal wound. The primary outcome measures in this study were local and systemic tumour recurrence and overall patient survival.
  
  
  RESULTS
  Fifty-three patients undergoing APR were included in the current study. Majority of patients (87%) received neoadjuvant therapy. Perineal morbidity was observed in 11% of patients loco-regional recurrence occurred in 4% at 5 years. One-, 3- and 5-year survival was 87, 75 and 66%, respectively. Patients with T3/4 disease and positive circumferential surgical margins had significantly poorer survival outcomes.
  
  
  CONCLUSIONS
  APR can be performed in the lithotomy position with acceptable perineal morbidity and oncological safety. Negative circumferential margins can be achieved reliably by producing a cylindrical specimen with this position.
authors.affiliation: Launceston General Hospital, Launceston, Tasmania, Australia.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Toshniwal
authors.forename: Marlon
authors.initials: M
authors.lastname: Perera
authors.forename: David
authors.initials: D
authors.lastname: Lloyd
authors.forename: Hung
authors.initials: H
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: adenocarcinoma/mortality; adenocarcinoma/surgery; neoplasm recurrence; perineum/surgery; rectal neoplasms/mortality; rectal neoplasms/surgery; rectum/surgery; survival rate