Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
J Surg Res. 2019 Nov;243:469-480. doi: 10.1016/j.jss.2019.07.005. Epub 2019 Aug 1.
Abdominoperineal resection (APR) is the primary surgical approach to low rectal cancers. Both prone and lithotomy patient positioning during the perineal dissection are currently acceptable approaches. There is no consensus on whether patient positioning has an impact on operative and oncologic outcomes. The aim of this review was to compare the perioperative and long-term oncologic outcomes between prone and lithotomy patient positioning.
Search of Medline, Embase, Web of Science, CENTRAL, PubMed, and ClinicalTrials.gov databases was performed. Articles were eligible for inclusion if they compared prone and lithotomy positioning for the perineal portion of APR for rectal cancer in one of the primary outcomes. Quality of included studies was assessed using Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool.
Nine studies with 888 patients in the prone group and 897 in the lithotomy group were included. Compared with lithotomy position, prone position had a significantly lower perforation rate (risk ratio: 0.50, 95% confidence interval [CI]: 0.32 to 0.79, P = 0.003) and rates of positive circumferential resection margin involvement (risk ratio: 0.66, 95% CI: 0.44 to 1.00, P = 0.05). Prone position also had a significantly shorter operative time than lithotomy position (mean difference: -45.20 min, 95% CI: -63.03 to -27.36, P < 0.00001). Positioning did not affect 5-y overall survival or local and distal recurrence.
Prone positioning may lead to lower rates of perforation and circumferential resection margin involvement in APR. In addition, it may lead to shorter operative time. Larger randomized studies are required to confirm the results of this review and examine the difference in long-term outcomes.
腹会阴联合切除术（APR）是治疗低位直肠癌的主要手术方法。目前，会阴部切开时患者采取俯卧位或截石位都是可接受的方法。然而，对于患者体位是否会影响手术和肿瘤学结果，目前尚无共识。本综述的目的是比较俯卧位和截石位患者体位对 APR 治疗直肠癌的围手术期和长期肿瘤学结果的影响。
对 Medline、Embase、Web of Science、CENTRAL、PubMed 和 ClinicalTrials.gov 数据库进行了搜索。如果文章比较了 APR 治疗直肠癌时会阴部采用俯卧位和截石位的一种主要结果，则将其纳入。使用纽卡斯尔-渥太华量表和 Cochrane 偏倚风险工具评估纳入研究的质量。
纳入了 9 项研究，其中俯卧组 888 例，截石组 897 例。与截石位相比，俯卧位的穿孔率显著降低（风险比：0.50，95%置信区间 [CI]：0.32 至 0.79，P=0.003），且环周切缘阳性率也降低（风险比：0.66，95%CI：0.44 至 1.00，P=0.05）。俯卧位的手术时间也显著短于截石位（平均差值：-45.20 分钟，95%CI：-63.03 至 -27.36，P<0.00001）。两种体位对 5 年总生存率以及局部和远处复发均无影响。
俯卧位可能会降低 APR 中穿孔和环周切缘阳性的发生率。此外，它还可能缩短手术时间。需要更大规模的随机研究来证实本综述的结果，并研究长期结果的差异。
