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Time to Chemotherapy After Abdominoperineal Resection: Comparison Between Primary Closure and Perineal Flap Reconstruction

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Abstract

Background

Wound complications are frequent flowing abdominoperineal resection (APR); this can lengthen the time to chemotherapy. Flap reconstruction is being used in an attempt to improve wound healing.

Objectives

To assess the effect of flap reconstruction after APR on time to perineal wound healing and administration of adjuvant chemotherapy in patients with rectal adenocarcinoma.

Methods

A retrospective review of patients who underwent APR for rectal adenocarcinoma between 2002 and 2012 was performed. Patients were divided into two groups based on type of perineal wound closure (primary vs. flap). Patients were compared for time to perineal wound healing, and time to adjuvant chemotherapy.

Results

115 patients were identified; of whom 67 received adjuvant chemotherapy. 56 (84 %) patients underwent primary closure while 11 (16 %) underwent flap reconstruction. There was no difference in time to perineal wound healing (6.8 vs. 6.3 weeks, p = 0.40) and time to receive adjuvant chemotherapy (9.3 vs. 10.7 weeks, p = 0.79) between the primary closure and flap reconstruction groups, respectively. 25 (45 %) of the primary closure group had a delay in receiving adjuvant chemotherapy versus 6 (55 %) of the flap reconstruction group (p = 0.55). Delay in receiving adjuvant chemotherapy because of perineal wound complications occurred in 18 (32 %) patients with primary closure versus 3 (28 %) patients with flap reconstruction (p = 0.14).

Conclusions

Flap reconstruction does not reduce the length of time to initiating chemotherapy; there was no difference in length of healing between the two groups. Therefore, flap reconstruction should be selectively used based on the size of the perineal defect.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA

    Azah A. Althumairi, Nita Ahuja, Bashar Safar & Jonathan E. Efron

  2. Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Joseph K. Canner

  3. Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Justin M. Sacks

Authors
  1. Azah A. Althumairi
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  2. Joseph K. Canner
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  3. Nita Ahuja
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  4. Justin M. Sacks
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  5. Bashar Safar
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  6. Jonathan E. Efron
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Correspondence to Jonathan E. Efron.

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Additional information

This paper has been presented as a poster presentation at the annual meeting of the Society of Surgical Oncology, Houston, TX, March 25–28, 2015.

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Althumairi, A.A., Canner, J.K., Ahuja, N. et al. Time to Chemotherapy After Abdominoperineal Resection: Comparison Between Primary Closure and Perineal Flap Reconstruction. World J Surg 40, 225–230 (2016). https://doi.org/10.1007/s00268-015-3224-0

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  • DOI: https://doi.org/10.1007/s00268-015-3224-0

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