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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.

Summary The impact of hyponatremia on waitlist and post‐transplant outcomes following the implementation of MELD‐Na‐based liver allocation remains unclear. We investigated waitlist and postliver transplant (LT) outcomes in patients with hyponatremia before and after implementing MELD‐Na‐based allocation. Adult patients registered for a primary LT between 2009 and 2021 were identified in the OPTN/UNOS database. Two eras were defined; pre‐MELD‐Na and post‐MELD‐Na. Extreme hyponatremia was defined as a serum sodium concentration ≤120 mEq/l. Ninety‐day waitlist outcomes and post‐LT survival were compared using Fine‐Gray proportional hazard and mixed‐effects Cox proportional hazard models. A total of 118 487 patients were eligible (n = 64 940: pre‐MELD‐Na; n = 53 547: post‐MELD‐Na). In the pre‐MELD‐Na era, extreme hyponatremia at listing was associated with an increased risk of 90‐day waitlist mortality ([ref: 135–145] HR: 3.80; 95% CI: 2.97–4.87; P < 0.001) and higher transplant probability (HR: 1.67; 95% CI: 1.38–2.01; P < 0.001). In the post‐MELD‐Na era, patients with extreme hyponatremia had a proportionally lower relative risk of waitlist mortality (HR: 2.27; 95% CI 1.60–3.23; P < 0.001) and proportionally higher transplant probability (HR: 2.12; 95% CI 1.76–2.55; P < 0.001) as patients with normal serum sodium levels (135–145). Extreme hyponatremia was associated with a higher risk of 90, 180, and 365‐day post‐LT survival compared to patients with normal serum sodium levels. With the introduction of MELD‐Na‐based allocation, waitlist outcomes have improved in patients with extreme hyponatremia but they continue to have worse short‐term post‐LT survival.