{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:36:46Z","timestamp":1787240206762,"version":"build-2736575974"},"reference-count":39,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Abdominal perineal resection (APR) remains the gold standard for lower rectal cancer involving the anal sphincter. However, the optimal patient position remains unclear. While lithotomy or Lloyd-Davies are commonly used, APR and extra-levator abdominal perineal excision (ELAPE) in a prone jackknife position have been linked to better oncological outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We searched PubMed, Embase, the Central Register of Clinical Trials, and Web of Science for randomized controlled trials (RCTs) and observational studies published up to February 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistics. Statistical analysis was performed with R Software version 4.4.1.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Two RCTs and 26 observational studies, including 4529 patients, were analyzed. Among them, 2249 (49.7%) underwent APR or ELAPE in the prone position and 2280 (50.3%) in the supine position. The prone position was associated with reduced surgical specimen perforation (5.3% versus 9.4%; OR: 0.44; 95% CI: 0.39\u20130.78;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), lower positive circumferential resection margins (CRMs) rates (9.8% versus 14.3%; OR: 0.69; 95% CI: 0.53\u20130.89;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), and decreased intraoperative bleeding (mean difference: \u201363.7 mL; 95% CI: \u2212104.5, \u221222.8;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01). No significant differences were observed in operative time, urinary retention, urinary injury, wound infections, perineal dehiscence, Clavien\u2013Dindo \u22653, reoperation, local recurrence, distal recurrence, or overall survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The prone position during APR is associated with reduced specimen perforation, lower positive CRM rates, and less intraoperative bleeding without significant differences in other clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lap.2024.0372","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T03:01:51Z","timestamp":1741143711000},"page":"224-239","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Abdominoperineal Resection in Prone Versus Supine Position: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2960-3810","authenticated-orcid":false,"given":"Bernardo Fontel","family":"Pompeu","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo-SP, Brazil."},{"name":"USCS \u2013 University of S\u00e3o Caetano do Sul, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Pasqualotto","sequence":"additional","affiliation":[{"name":"Federal University of Santa Catarina, Florian\u00f3polis-SC, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz D'Andrea","family":"Pigossi","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matheus Reginato","family":"Araujo","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7687-3073","authenticated-orcid":false,"given":"Lucas Monteiro","family":"Delgado","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais \u2013 UFMG, Belo Horizonte, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Soares de Souza Pinto","family":"Guedes","sequence":"additional","affiliation":[{"name":"USCS \u2013 University of S\u00e3o Caetano do Sul, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Mazzola","family":"Poli de Figueiredo","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Bellotti","family":"Formiga","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo-SP, Brazil."},{"name":"Department of Colorectal Surgery, Medical Science College of Santa Casa de S\u00e3o Paulo, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000002122"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12148"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e318221eb64"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2017.05.021"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2020.0969"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-015-0453-5"},{"issue":"5","key":"e_1_3_5_8_2","first-page":"e1643","article-title":"Comparative study between amputation of the rectum in the classic Lloyd-Davies position and in ventral decubitus","volume":"45","author":"Novais RB","year":"2018","unstructured":"Novais RB, , Barbosa AAL, , Intelizano PM, et al. Comparative study between amputation of the rectum in the classic Lloyd-Davies position and in ventral decubitus. Rev Col Bras Cir, 2018; 45(5):e1643; doi: 10.1590\/0100-6991e-20181643","journal-title":"Rev Col Bras Cir"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.3393\/ac.2016.32.1.12"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.14.5961"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-014-2683-1"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2012.05.001"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e31823e2424"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5489"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e318221eb80"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25402"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.07.005"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_5_19_2","unstructured":"U.S. National Institute of Health Research. PROSPERO. International prospective register of systematic reviews. n.d. Available from: https:\/\/www.crd.york.ac.uk\/prospero\/"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"issue":"5","key":"e_1_3_5_22_2","article-title":"Extra levator with vertical rectus abdominis myocutaneous flap versus nonextra-levator abdominoperineal excision for rectal cancer: The relape trial","volume":"59","author":"Bianco F","year":"2016","unstructured":"Bianco F, , Giovanni R, , Tsarkov P, et al. Extra levator with vertical rectus abdominis myocutaneous flap versus nonextra-levator abdominoperineal excision for rectal cancer: The relape trial. Dis Colon Rectum, 2016; 59(5); doi: 10.1111\/codi.13436","journal-title":"Dis Colon Rectum"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2012.02930.x"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-018-2977-y"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000639"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000910"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-3963-1"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2016.07.016"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2017.0093"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2019.05.006"},{"issue":"4","key":"e_1_3_5_31_2","first-page":"244","article-title":"Extra-levator abdominoperineal excision versus conventional surgery for low rectal cancer: A single surgeon experience","volume":"32","author":"Ne\u015f\u015far G","year":"2016","unstructured":"Ne\u015f\u015far G, , Demirba\u011f AE, , Celep B, et al. Extra-levator abdominoperineal excision versus conventional surgery for low rectal cancer: A single surgeon experience. Ulus Cerrahi Derg, 2016; 32(4):244\u2013247; doi: 10.5152\/UCD.2016.3426","journal-title":"Ulus Cerrahi Derg"},{"issue":"4","key":"e_1_3_5_32_2","first-page":"34","article-title":"Comparative study of extra-levator versus conventional abdominoperineal excision in a single center in the developing world","volume":"54","author":"Oostenbroek M","year":"2016","unstructured":"Oostenbroek M, , Coetzee E, , Boutall A, et al. Comparative study of extra-levator versus conventional abdominoperineal excision in a single center in the developing world. South African Journal of Surgery, 2016; 54(4):34\u201339; doi: 10.17159\/2078-5151\/2016\/v54n4a1775","journal-title":"South African Journal of Surgery"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9522"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-014-1243-8"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2015.01.017"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00053-019-00422-y"},{"issue":"3","key":"e_1_3_5_37_2","first-page":"21","article-title":"Extra-levator Abdominoperineal Excision (ELAPE) is Not Superior to Abdominoperineal Excision (APE) in the era of neoadjuvant treatment in rectal cancer","volume":"43","author":"Ulusoy C","year":"2022","unstructured":"Ulusoy C, , Nikolovski A. Extra-levator Abdominoperineal Excision (ELAPE) is Not Superior to Abdominoperineal Excision (APE) in the era of neoadjuvant treatment in rectal cancer. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 2022; 43(3):21\u201327; doi: 10.2478\/prilozi-2022-0033","journal-title":"Pril (Makedon Akad Nauk Umet Odd Med Nauki)"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-022-01692-y"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2009.01939.x"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-018-3750-9"}],"container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/lap.2024.0372","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/lap.2024.0372","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/lap.2024.0372","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T20:00:43Z","timestamp":1777665643000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.1089\/lap.2024.0372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1089\/lap.2024.0372"],"URL":"https:\/\/doi.org\/10.1089\/lap.2024.0372","relation":{},"ISSN":["1092-6429","1557-9034"],"issn-type":[{"value":"1092-6429","type":"print"},{"value":"1557-9034","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}