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A 12‐year experience of the T rendelenburg perineal approach for abdominoperineal resection
Author(s) -
Toshniwal Sumeet,
Perera Marlon,
Lloyd David,
Nguyen Hung
Publication year - 2013
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12137
Subject(s) - medicine , lithotomy position , abdominoperineal resection , surgery , perineum , colorectal cancer , cancer , alternative medicine , pathology
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 T 3/4 disease and positive circumferential surgical margins had significantly poorer survival outcomes. Conclusion 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.