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Purpose:

Positive radial margins and intraoperative rectal perforation adversely affect outcome after abdominoperineal resection (APR) for low rectal cancer. Use of the prone jackknife position during the perineal dissection may improve exposure and therefore oncologic outcome. Our purpose was to determine whether performing the perineal dissection of APR in prone jackknife versus lithotomy position improves radial margin clearance and reduces intraoperative rectal perforations.

Methods:

An IRB-approved retrospective review of 130 cases of APRs over 8 years was performed after excluding patients with no radial margin reported, non-adenocarcinoma pathology, and pelvic exenterations. Primary endpoints of radial margin and intraoperative rectal perforation were obtained from pathology reports. Data on patient demographics, preoperative staging, preoperative therapy, and intraoperative positioning was obtained. Statistical analysis was performed using t test or Fisher’s exact test with significance set at p<0.05.

Results:

Perineal dissection was performed in prone jackknife position in 65 patients and in lithotomy position in 65 patients. There were no significant differences between these groups in terms of patient gender, age, percent receiving preoperative therapy, distance of tumor from dentate line, or preoperative stage. There was no significant difference in mean radial margin between patients whose perineal dissection was performed in the prone jackknife versus lithotomy position (0.54 cm vs. 0.56 cm, p=0.76). The percent of positive radial margins in each group was not significantly different (17% vs. 13%, p=0.62) and the percent of intraoperative rectal perforations in each group also did not differ (13% vs. 24%, p=0.35). There was a trend toward decreased operative time in lithotomy (196 min vs. 222 min, p=0.12).

Conclusions:

APR with perineal dissection performed in prone jackknife position is associated with longer operative times compared to lithotomy position and does not appear to confer any oncologic advantage with respect to radial margin clearance or intraoperative rectal perforation.