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Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment

International Journal of Colorectal Disease volume 29, pages 1151–1157 (2014)Cite this article

Abstract

Purpose

Intensified treatment for distal rectal cancer has improved oncological outcome, but at the expense of more perineal wound complications in patients undergoing an abdominoperineal resection (APR). The aim of this study was to analyse perineal wound healing after APR with primary perineal wound closure over time.

Method

All patients undergoing APR for primary rectal cancer with primary wound closure between 2000 and 2013 were included and analysed in three consecutive time periods. Both early (<30 days postoperatively) and late perineal wound complications were determined. Independent risk factors of early perineal wound complications were identified using multivariable analysis.

Results

A total of 136 patients were identified, of whom 129 patients underwent primary perineal wound closure. The use of neo-adjuvant (chemo)radiotherapy increased from 72 to 91 %, and the use of an extralevator approach increased from 9 to 19 %. The rate of early perineal wound complications increased from 18 to 31 % and was independently associated with an extralevator approach [odds ratio (OR) 3.17; 95 % confidence interval (CI) 1.16–8.66] and intra-operative perforation (OR 3.35; 95 % CI 1.06–10.57). Perineal wound complications had no impact on local recurrence or 3-year overall survival rate. During a median follow-up of 28 months [interquartile range (IQR) 14–56], a persistent presacral sinus was diagnosed in 10 %, and a perineal hernia occurred in 8 % of the patients.

Conclusion

The increased use of an extralevator APR for rectal cancer significantly increased the risk of perineal wound complications over time. Intra-operative perforation was also independently associated with impaired perineal wound healing.

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Conflict of interest

The authors have no conflicts of interest.

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Affiliations

  1. Department of Surgery, Academic Medical Centre, University of Amsterdam, G4, Post Box 22660, 1105 AZ, Amsterdam, The Netherlands

    Gijsbert D. Musters, Didi A. M. Sloothaak, Sapho Roodbeen, Willem A. Bemelman & Pieter J. Tanis

  2. Department of Surgery, Tergooiziekenhuizen, Post Box 10016, 1201 DA, Hilversum, The Netherlands

    Anna A. W. van Geloven

Authors
  1. Gijsbert D. Musters
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  2. Didi A. M. Sloothaak
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  3. Sapho Roodbeen
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  4. Anna A. W. van Geloven
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  5. Willem A. Bemelman
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  6. Pieter J. Tanis
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Corresponding author

Correspondence to Pieter J. Tanis.

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Musters, G.D., Sloothaak, D.A.M., Roodbeen, S. et al. Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment. Int J Colorectal Dis 29, 1151–1157 (2014). https://doi.org/10.1007/s00384-014-1967-y

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  • DOI: https://doi.org/10.1007/s00384-014-1967-y

Keywords

  • Abdominoperineal resection
  • Rectal cancer
  • Radiotherapy
  • Primary perineal wound closure
  • Perineal wound infection
  • Perineal wound complication