Anne M Dinaux1, Ramzi Amri1, David L Berger2. 1. Division: Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 2. Division: Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: dberger@mgh.harvard.edu.
Abstract
BACKGROUND: Abdominoperineal resection (APR) remains the cornerstone treatment for rectal cancers less than 5 cm from the anal verge. The perineal portion of an APR can be done with the patient in lithotomy or repositioned to prone jack-knife position, which influences accessibility, visualization and ability to close the wound. This paper analyses the effect of patient positioning on perineal wound dehiscence and infections. METHODS: A retrospective review of all rectal cancer patients who underwent an APR at Massachusetts General Hospital between 2004 and 2014 (n = 149). Patients were divided into supine (n = 91) or prone (n = 58) positioning as documented in operative reports. RESULTS: Twenty-two percent of supine positioned patients developed a perineal wound infection, versus 3.4% of the prone patients (P = 0.002). Perineal wound dehiscence rate was also higher in the supine positioned group (14.3% vs. prone 3.4%; P = 0.032). Multivariable analysis showed OR = 9.2 of developing a perineal wound infection for supine positioned patients, compared to prone, corrected for obesity and smoking history. CONCLUSION: Repositioning patients into prone position for the perineal portion of an APR was associated with significantly lower perineal wound infection and dehiscence rates compared to supine positioned patients.
BACKGROUND: Abdominoperineal resection (APR) remains the cornerstone treatment for rectal cancers less than 5 cm from the anal verge. The perineal portion of an APR can be done with the patient in lithotomy or repositioned to prone jack-knife position, which influences accessibility, visualization and ability to close the wound. This paper analyses the effect of patient positioning on perineal wound dehiscence and infections. METHODS: A retrospective review of all rectal cancerpatients who underwent an APR at Massachusetts General Hospital between 2004 and 2014 (n = 149). Patients were divided into supine (n = 91) or prone (n = 58) positioning as documented in operative reports. RESULTS: Twenty-two percent of supine positioned patients developed a perineal wound infection, versus 3.4% of the prone patients (P = 0.002). Perineal wound dehiscence rate was also higher in the supine positioned group (14.3% vs. prone 3.4%; P = 0.032). Multivariable analysis showed OR = 9.2 of developing a perineal wound infection for supine positioned patients, compared to prone, corrected for obesity and smoking history. CONCLUSION: Repositioning patients into prone position for the perineal portion of an APR was associated with significantly lower perineal wound infection and dehiscence rates compared to supine positioned patients.
Authors: Jose Wilson B Mesquita-Neto; Hassan Mouzaihem; Francisco Igor B Macedo; Lance K Heilbrun; Donald W Weaver; Steve Kim Journal: J Surg Oncol Date: 2019-02-06 Impact factor: 3.454