Academic Surgical Unit, University of Hull, Castle Hill Hospital, Cottingham, United Kingdom.
Dis Colon Rectum. 2012 Mar;55(3):316-21. doi: 10.1097/DCR.0b013e31823e2424.
Abdominoperineal excision of rectum has been associated with poor oncological specimens and high local recurrence rates in comparison with restorative surgery. The role of recent changes in operative position has yet to be evaluated.
This study aimed to determine whether a change in the perineal phase from the Lloyd-Davies position to the prone jackknife position might improve excision margins and oncological outcomes.
A single-institution review of a prospectively maintained database comparing the quality of excision and oncological outcomes after abdominoperineal excision in conventional and prone position was performed. Consecutive abdominoperineal excisions performed for adenocarcinoma of the rectum between January 1999 and April 2008 were included.
Abdominoperineal excision cases were assessed including 63 in the Lloyd-Davies position and 58 in the prone jackknife position. The 5-year local recurrence rate was 5% in the prone jackknife group in comparison with 23% in the Lloyd-Davies group (p = 0.03) by life table analysis. For local recurrence, the most significant and independent risk factors were a favorable effect of having the patient in the prone jackknife position for the perineal phase of abdominoperineal excision (HR 0.2; 95% CI 0.04-0.81) and, unfavorably, a positive circumferential resection margin (HR 7.1; 95% CI 2.4-20). Lymph node involvement (N2) was an independent risk factor for overall survival (HR 4.6; 95% CI 2.1-9.5) and relapse of disease (HR 4.0; 95% CI 0.7-9.4).
This study has some limitations because it is a retrospective review of a prospective database.
These data suggest that the rate of local recurrence after abdominoperineal excision may be lowered by adaptation of the prone jackknife position.
与保肛手术相比，腹会阴联合切除术的标本质量较差，局部复发率较高。手术体位的近期变化的作用尚未得到评估。
本研究旨在确定会阴期从 Lloyd-Davies 体位改为俯卧位是否可以改善切缘和肿瘤学结果。
对一家机构前瞻性维护的数据库进行回顾性分析，比较传统体位和俯卧位行腹会阴联合切除术后的切除质量和肿瘤学结果。纳入 1999 年 1 月至 2008 年 4 月连续进行的直肠腺癌腹会阴联合切除术病例。
评估了 63 例 Lloyd-Davies 体位和 58 例俯卧位的腹会阴联合切除病例。通过生命表分析，俯卧位组的 5 年局部复发率为 5%，而 Lloyd-Davies 组为 23%（p = 0.03）。对于局部复发，最重要和独立的危险因素是患者在俯卧位进行腹会阴联合切除的会阴期（HR 0.2；95%CI 0.04-0.81），以及不利的是，阳性环周切缘（HR 7.1；95%CI 2.4-20）。淋巴结受累（N2）是总生存（HR 4.6；95%CI 2.1-9.5）和疾病复发（HR 4.0；95%CI 0.7-9.4）的独立危险因素。
本研究存在一些局限性，因为它是对前瞻性数据库的回顾性分析。
这些数据表明，通过采用俯卧位，可能会降低腹会阴联合切除术后局部复发率。
