Clinical Study On The Use Of Prone Jackknife Position To Perform Abdominal Perineal Resection Of Low Rectal Cancer Under The Guidance Of Enhanced Recovery After Surgery

Objective:To explore the safety and effectiveness of prone jackknife position to perform abdominoperineal resection（APR）of low rectal cancer under the guidance of enhanced recovery after surgery（ERAS）.Methods:A retrospective review of 112 low rectal cancer patients who underwent APR at Jinling Hospital during Feb.2013 and Oct.2017 was conducted.Patients were divided into prone jackknife position group（n=59）or lithotomy position group（n=53）as documented in operative reports.The operation time,intraoperative perineum hemorrhage,intraoperative complications,postoperative pain Visual Analogue Score（VAS）in bed,time of first postoperative ambulation,stoma exhaust time,recovery time of urinary function,postoperative transoral semi-fluid diet time,indwelling time of abdominal drainage tube,postoperative hospital stay and postoperative complications were observed and compared between the two groups.Results:The operation time of the prone jackknife group and the lithotomy group were（188.29±47.30）and（184.46±53.12）min,the intraoperative perineal blood loss were（57.62±29.24）and（78.13±32.68）ml,the intraoperative complication rates were 1.69%and 5.66%respectively.It indicated that the intraoperative perineal blood loss in the prone jackknife group was less than that in the lithotomy group（P<0.5）,there was no significant difference in operation time and intraoperative complication rates between the two groups（P>0.5）.2.The postoperative pain VAS in bed on 3 days after surgery of the prone jackknife group and the lithotomy group were（4.91±0.79,3.62±1.14,2.24±0.41）and（5.13±0.92,3.92±1.03,2.46±0.37）,the time of first postoperative ambulation were（21.25±11.86）and（24.58±12.17）hours,the stoma exhaust time were（28.78±11.30）and（26₀6±8.81）hours,the recovery time of urinary function were（30.80± 13.13）and（32.13± 12.94）hours,the postoperative transoral semi-fluid diet time were（37.12±9.56）and（35.46±10.33）hours,the indwelling time of abdominal drainage tube were（5.15±1.73）and（5.91±1.75）days,and the median postoperative hospital stay were 7（6,9）and 8（7,12）days,respectively.It suggest that the indwelling time of abdominal drainage tube and postoperative hospital stay were shorter in the prone jackknife group than that in the lithotomy group（P<0.5）,there were no significant differences between the two groups in postoperative pain VAS,the time of first postoperative ambulation,stoma exhaust time,the recovery time of urinary function and transoral semi-fluid diet time（P>0.5）.Postoperative perineal wound complication rate reached 15.09%in the lithotomy group,which was significantly higher than the 5.08%in the prone jackknife group（x2=5.556,P=0.018）,and the total complication rates after the prone jackknife group was lower than that of the lithotomy group（10.17%vs.20.75%,χ2=4.619,P=0.032）.Conclusions:Prone jackknife position is feasible and effective for low rectal cancer patients undergoing APR under the guidance of ERAS,which can shortening postoperative hospital stay and accelerating postoperative recovery.Compared with the lithotomy position,prone jackknife position has the advantages of easier exposure of perineal surgery area,better surgical field of vision,exact hemostasis,and lower incidence of perineal incision complications.