A 12-year experience of the Trendelenburg perineal approach for abdominoperineal resection.
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 T3/4 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.
['Toshniwal|Sumeet|S|', 'Perera|Marlon|M|', 'Lloyd|David|D|', 'Nguyen|Hung|H|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D015897:Comorbidity D013505:Digestive System Surgical Procedures D005260:Female D018475:Head-Down Tilt D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D020360:Neoadjuvant Therapy D010502:Perineum D011183:Postoperative Complications D012004:Rectal Neoplasms D012189:Retrospective Studies D016896:Treatment Outcome
adenocarcinoma/mortality adenocarcinoma/surgery neoplasm recurrence perineum/surgery rectal neoplasms/mortality rectal neoplasms/surgery rectum/surgery survival rate