Perioperative and oncological outcomes of abdominoperineal resection in the prone position vs the classic lithotomy position: A systematic review with meta‐analysis
Autor: | Donald W. Weaver, Hassan Mouzaihem, Lance K. Heilbrun, Jose Wilson Mesquita-Neto, Steve Kim, Francisco Igor B. Macedo |
---|---|
Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
Perforation (oil well) Rectum Patient Positioning Article 03 medical and health sciences 0302 clinical medicine Prone Position medicine Humans Randomized Controlled Trials as Topic Retrospective Studies Proctectomy Rectal Neoplasms Abdominoperineal resection business.industry Margins of Excision General Medicine Perioperative Odds ratio Surgery Lithotomy position Prone position Treatment Outcome medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Meta-analysis 030211 gastroenterology & hepatology business |
Zdroj: | J Surg Oncol |
ISSN: | 1096-9098 0022-4790 |
Popis: | BACKGROUND AND OBJECTIVES: This study is a systematic review with meta-analysis designed to compare the perioperative and oncological outcomes of the abdominoperineal resection (APR) carried out in the prone jack-knife position (P-APR) vs the classic lithotomy position (C-APR). METHODS: We conducted an electronic search through PubMed utilizing the PRISMA guidelines. We included all randomized and nonrandomized studies which allowed for comparative analysis between the two groups. Research that focused on and analyzed the extralevator abdominal excision were excluded. Pooled variables and number of events were analyzed using the random-effect model. RESULTS: The final analysis included seven nonrandomized retrospective cohorts encompassing 1663 patients. P-APR was associated with decreased operative time (OT) (DM, −43.8 minutes; P < 0.01) and estimated blood loss (EBL) (DM, 86.9 mL; P < 0.01). There were no observed differences regarding perineal wound infections (PWI) (odds ratio [OR], 0.36; P = 0.18), intraoperative perforation of rectum (IOP) (OR, 0.98; P = 0.97), circumferential resection margin (CRM) positivity (OR, 1.02; P = 0.98) or 5-year LR (OR, 1.00; P = 0.99). CONCLUSION: The prone approach for APR is associated with decreased EBL and OT, although not with any change in the incidence of PWI or IOP. Moreover, surgical positioning per se does not appear to affect the CRM positivity rates or LR rate. |
Databáze: | OpenAIRE |
Externí odkaz: |