Division of Colorectal Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
J Laparoendosc Adv Surg Tech A. 2021 Apr;31(4):382-389. doi: 10.1089/lap.2020.0969. Epub 2021 Feb 26.
It is unclear whether the supine or prone approach for abdominoperineal resection (APR) influences outcomes. In a retrospective study of patients with rectal cancer who underwent curative laparoscopic APR from 2005 to 2018, we compared perioperative data, postoperative outcomes, oncological outcomes, and survival between the two approaches. We recruited 123 patients (58 for the supine group and 65 for the prone group), with a median age of 72 (41-93) years. Mean follow-up was 67.4-45.7 months (28-169) in the supine group and 47.8-30.9 months (13-158) in the prone group ( = .026). Duration of surgery was longer in the prone group at 237 ± 52.3 minutes versus 210 ± 56.6 minutes in the supine group ( = .007). The incidence of tumor perforation during surgery was 9% in the supine group versus 3% in the prone group ( = .208). The incidence of perineal wound infection did not differ significantly between groups (supine 22% versus prone 20%, = .93). The mesorectum was incomplete in 25% cases in the supine group and 14% cases in the prone group ( = .175). Circumferential resection margin positivity was 21% in the supine group and 14% in the prone group ( = .374). Local and distant recurrence was higher in patients with adenocarcinoma in the supine group at 10% and 31% versus 4% and 17% in the prone group ( = .177). Overall survival was higher in the prone group: 4% of patients died due to disease progression compared with 24% in the supine group ( = .034). Our results suggest that morbidity is similar with both laparoscopic techniques, but long-term outcomes seem better with the prone approach.
对于经腹会阴切除术（APR），采用仰卧位还是俯卧位尚不清楚是否会影响结果。在一项回顾性研究中，我们比较了 2005 年至 2018 年接受腹腔镜根治性 APR 的直肠癌患者的围手术期数据、术后结果、肿瘤学结果和生存情况。共纳入 123 例患者（仰卧位组 58 例，俯卧位组 65 例），中位年龄为 72 岁（41-93 岁）。仰卧位组的中位随访时间为 67.4-45.7 个月（28-169 个月），俯卧位组为 47.8-30.9 个月（13-158 个月）（=0.026）。俯卧位组的手术时间为 237±52.3 分钟，而仰卧位组为 210±56.6 分钟（=0.007）。仰卧位组术中肿瘤穿孔发生率为 9%，而俯卧位组为 3%（=0.208）。两组会阴伤口感染发生率无显著差异（仰卧位组 22%，俯卧位组 20%，=0.93）。仰卧位组中 25%的病例直肠系膜不完全，而俯卧位组中 14%的病例直肠系膜不完全（=0.175）。仰卧位组的环周切缘阳性率为 21%，而俯卧位组为 14%（=0.374）。仰卧位组腺癌患者局部和远处复发率分别为 10%和 31%，而俯卧位组分别为 4%和 17%（=0.177）。俯卧位组的总生存率更高：由于疾病进展，4%的患者死亡，而仰卧位组为 24%（=0.034）。我们的结果表明，两种腹腔镜技术的发病率相似，但俯卧位技术的长期结果似乎更好。
