Vertical Rectus Abdominis Musculocutaneous Flap Repair Improves Perineal Wound Healing after Abdominoperineal Resection for Irradiated Locally Advanced Rectal Cancer
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Radiotherapy (RT) and subsequent abdominoperineal resection (APR) for locally advanced rectal cancer (LARC) is associated with significant perineal wound morbidity. The aim of the present study was to investigate if vertical rectus abdominis musculocutaneous (VRAM) flap repair after APR in LARC patients improves perineal wound healing compared with direct perineal wound closure (non-VRAM).
LARC patients (n = 329) operated with APR between January 2006 and December 2015 after neoadjuvant RT of ≥ 25 Gy were identified, including 260 and 69 patients in the non-VRAM and VRAM groups, respectively. Perineal wound healing was assessed 3 months postoperatively, and risk factors for perineal wound complications and associations with short- and long-term outcome were analyzed.
Delayed perineal wound healing after 3 months was more frequent in the non-VRAM group (31.5%) compared with the VRAM group (10.4%) (p < 0.01). In the non-VRAM group, 26.9% of patients developed pelvic abscess, compared with 10.1% in the VRAM group (p < 0.01). Significant risk factors for perineal wound morbidity were non-VRAM (odds ratio [OR] 3.94, 95% confidence interval [CI] 1.72–9.00; p = 0.02), positive circumferential resection margin (R1; OR 3.64, 95% CI 1.91–6.93; p < 0.01), pelvic abscess (OR 3.27, 95% CI 1.90–5.63; p < 0.01), and short-course RT (OR 3.81, 95% CI 1.75–8.30; p < 0.01). Perineal wound morbidity was not associated with impaired long-term oncologic outcome.
VRAM flap reconstruction of the perineum is associated with an increased wound healing rate and may protect against pelvic abscess development. However, procedure-related long-term morbidity is incompletely studied and the procedure should be reserved for selected patients.
The authors would like to thank the staff at the Department of Gastroenterological Surgery, and Veronica M. Alexandersen, for their invaluable contributions to this work.
The authors declare no relevant financial relationships.
Milan Spasojevic, Anthony B. Mariathasan, Mariusz Goscinski, Ebbe B. Thorgersen, Arne M. Solbakken, Hans-Petter Gullestad, Truls Ryder, Kjersti Flatmark, and Stein G. Larsen declare no conflicts of interest.
- 9.Barker T, Branagan G, Wright E, Crick A, McGuiness C, Chave H. Vertical rectus abdominis myocutaneous flap reconstruction of the perineal defect after abdominoperineal excision is associated with low morbidity. Colorect Dis 2013;15:1177–83.Google Scholar
- 13.Edge SB, Byrd DR, Compton CC, et al. (eds) (2010) Colon and rectum AJCC Cancer Staging Manual. 7th ed. Springer, New York pp. 143–164.Google Scholar
- 15.Ansari N, Solomon MJ, Fisher RJ, et al. Acute adverse events and postoperative complications in a randomized trial of preoperative short-course radiotherapy versus long-course chemoradiotherapy for T3 adenocarcinoma of the rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). Ann Surg 2017;265:882–8.CrossRefPubMedGoogle Scholar
- 24.Shukla HS, Hughes LE. The rectus abdominis flap for perineal wounds. Ann Royal Coll Surg Engl 1984;66:337–9.Google Scholar
- 30.Prytz M, Angenete E, Bock D, Haglind E. Extralevator abdominoperineal excision for low rectal cancer—extensive surgery to be used with discretion based on 3-year local recurrence results: A Registry-based, Observational National Cohort Study. Ann Surg 2016;263:516–21.CrossRefPubMedPubMedCentralGoogle Scholar