title: Therapeutic results of abdominoperineal resection in the prone jackknife position for T3-4 low rectal cancers.
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.
authors.affiliation: Department of General Surgery, The First Affiliated Hospital, Dalian Medical University, No. 222 Zhongshan Road, Dalian, 116011, China, caoliang913@163.com.
authors.forename: Xiang
authors.initials: X
authors.lastname: Hu
authors.forename: Liang
authors.initials: L
authors.lastname: Cao
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.forename: Pin
authors.initials: P
authors.lastname: Liang
authors.forename: Ge
authors.initials: G
authors.lastname: Liu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D056446:Knee-Chest Position; D008297:Male; D008875:Middle Aged; D010502:Perineum; D016684:Prone Position; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome