title: Better operative outcomes achieved with the prone jackknife vs. lithotomy position during abdominoperineal resection in patients with low rectal cancer.
abstract: BACKGROUND
  Lithotomy (LT) and prone jackknife positions (PJ) 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. Patients were matched 1:2 (PJ-APR = 74 and LT-APR = 37 patients) based on gender and age. Perioperative data, postoperative outcomes, and survival were compared between the two approaches.
  
  
  RESULTS
  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.
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, China. 482568965@qq.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, China. doctorbaohaidong@163.com.
authors.forename: Haidong
authors.initials: H
authors.lastname: Bao
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, China. bzmczxb@163.com.
authors.forename: Xianbin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, China. dctorzhangjian@sina.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, Dalian Medical University, 9 Lvshun Road South, 116044, Dalian, China. mali_lele@sina.com.
authors.forename: Li
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, China. docwangyulin@163.com.
authors.forename: Yulin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, China. gilichunyan@163.com.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, China. doctorzhongyuwang@163.com.
authors.forename: Zhongyu
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, China. medscigp@126.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Gong
mesh_terms: D000005:Abdomen / Q000473:pathology / Q000601:surgery*; D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000401:mortality*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010502:Perineum / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate