ABDOMINOPERINEAL RESECTION IN THE PRONE POSITION: EARLY OUTCOMES AT A TERTIARY INSTITUTION IN THE WESTERN CAPE, SOUTH AFRICA.

BACKGROUND: Abdominoperineal resection (APR) in the prone position is a new technique in the developing world, where colorectal cancer incidence is rising fast and the patient population is different from those in the developed world. Literature is lacking on the outcomes of this technique under these conditions.

METHOD: All patients who underwent APR in the prone position for rectal adenocarcinoma from February 2011 to February 2017 were reviewed. Main endpoints were stage at presentation, neoadjuvant treatment, circumferential resection margin involvement, perineal wound complications, length of intensive care unit (ICU) stay and days discharged after surgery.

RESULTS: Fifty-four patients were included in the study. The average age of patients was 57 years (range 29-79yrs). Neoadjuvant (NA) chemoradiation was given in 54% while 14% of patients only received NA chemotherapy and 10% short course neoadjuvant radiotherapy. The average stage at presentation for rectal cancer was stage 3B. The circumferential resection margin (CRM) was involved in 14.8% (8/54) of patients. Perineal wound infection was identified in 25% (14/54) of patients and perineal wound dehiscence in 14%. Average length of ICU stay was 4.9 days and patients were discharged on average 10.7 days post operatively.

CONCLUSION: Patients in the developing world present with more advanced stage rectal cancer. Complete resection rates for rectal cancer after APR in the prone position compare to those achieved in developed countries. A high perineal wound complication rate was seen in this series. The high percentage of patients with locally advanced disease necessitating neoadjuvant radiotherapy possibly contributed towards this finding.