Skip to main content

Advertisement

SpringerLink
Log in

Extended pelvic resection for rectal and anal canal tumors is a significant risk factor for perineal wound infection: a retrospective cohort study

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Perineal wound infection (PWI) rates are high after abdominoperineal resection (APR) and total pelvic exenteration (TPE). This study identified risk factors for PWI after surgery for anorectal tumors and examined the relationship between the surgical excision volume with the PWI degree.

Methods

A retrospective review involving 135 patients who underwent surgical excision of anorectal tumors was performed. Superficial PWI included cellulitis and superficial dehiscence; deep PWI included major dehiscence, perineal abscess, and presacral abscess. The adjacent organ resection type was classified according to the dead space size formed by surgical excision.

Results

Of the 135 patients, 119 underwent APR, and 16 underwent TPE. PWI occurred in 75 patients (superficial PWI, 44; deep PWI, 31). Adjacent organ resection was an independent risk factor for PWI. The cases with adjacent organ resection were classified into small-defect APR, large-defect APR, and TPE. Large-defect APR and TPE cases had significantly higher rates of deep PWI than APR cases without adjacent organ resection.

Conclusions

Adjacent organ resection involving the removal of one or more organs and that involving wide-range muscle resection are strong risk factors for deep PWI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. de Bruin AF, Gosselink MP, Wijffels NA, Coene PP, van der Harst E. Local gentamicin reduces perineal wound infection after radiotherapy and abdominoperineal resection. Tech Coloproctol. 2008;12:303–7.

    Article  PubMed  Google Scholar 

  2. Kuhrt MP, Chokshi RJ, Arrese D, Martin EW Jr. Retrospective review of pelvic malignancies undergoing total pelvic exenteration. World J Surg Oncol. 2012;10:110.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Shukla HS, Tewari M. An evolution of clinical application of inferior pedicle based rectus abdominis myocutaneous flap for repair of perineal defects after radical surgery for cancer. J Surg Oncol. 2010;102:287–94.

    Article  CAS  PubMed  Google Scholar 

  4. Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg. 2007;94:232–8.

    Article  CAS  PubMed  Google Scholar 

  5. Althumairi AA, Canner JK, Gearhart SL, Safar B, Sacks J, Efron JE. Predictors of perineal wound complications and prolonged time to perineal wound healing after abdominoperineal resection. World J Surg. 2016;40:1755–62.

    Article  PubMed  Google Scholar 

  6. Nissan A, Guillem JG, Paty PB, Douglas Wong W, Minsky B, Saltz L, Cohen AM. Abdominoperineal resection for rectal cancer at a specialty center. Dis Colon Rectum. 2001;44:27–35.

    Article  CAS  PubMed  Google Scholar 

  7. El-Gazzaz G, Kiran RP, Lavery I. Wound complications in rectal cancer patients undergoing primary closure of the perineal wound after abdominoperineal resection. Dis Colon Rectum. 2009;52:1962–6.

    Article  PubMed  Google Scholar 

  8. Bullard KM, Trudel JL, Baxter NN, Rothenberger DA. Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum. 2005;48:438–43.

    Article  PubMed  Google Scholar 

  9. Musters GD, Buskens CJ, Bemelman WA, Tanis PJ. Perineal wound healing after abdominoperineal resection for rectal cancer. Dis Colon Rectum. 2014;57:1129–39.

    Article  PubMed  Google Scholar 

  10. West NP, Anderin C, Smith KJ, Holm T, Quirke P. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg. 2010;97:588–99.

    Article  CAS  PubMed  Google Scholar 

  11. Yu HC, Peng H, He XS, Zhao RS. Comparison of short- and long-term outcomes after extralevator abdominoperineal excision and standard abdominoperineal excision for rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2014;29:183–91.

    Article  PubMed  Google Scholar 

  12. West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol. 2008;26:3517–22.

    Article  PubMed  Google Scholar 

  13. Mesquita Neto JW, Machado DB, Macedo DJ, Cordeiro DF, Brito EV, Costa ML. Extended pelvic resections for the treatment of locally advanced and recurrent anal canal and colorectal cancer: technical aspects and morbimortality predictors after 24 consecutive cases. Rev Col Bras Cir. 2016;43:93–101.

    Article  Google Scholar 

  14. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  15. Combs PD, Sousa JD, Louie O, Said HK, Neligan PC, Mathes DW. Comparison of vertical and oblique rectus abdominis myocutaneous flaps for pelvic, perineal, and groin reconstruction. Plastic Reconst Surg. 2014;134:315–23.

    Article  CAS  Google Scholar 

  16. Sumrien H, Newman P, Burt C, McCarthy K, Dixon A, Pullyblank A, et al. The use of a negative pressure wound management system in perineal wound closure after extralevator abdominoperineal excision (ELAPE) for low rectal cancer. Tech Coloproctol. 2016;20:627–31.

    Article  CAS  PubMed  Google Scholar 

  17. Hay JM, Fingerhut A, Paquet JC, Flamant Y. Management of the pelvic space with or without omentoplasty after abdominoperineal resection for carcinoma of the rectum: a prospective multicenter study. The French Association for Surgical Research. Eur J Surg. 1997; 163:199–206.

    CAS  PubMed  Google Scholar 

  18. Hultman CS, Sherrill MA, Halvorson EG, Lee CN, Boggess JF, Meyers MO, et al. Utility of the omentum in pelvic floor reconstruction following resection of anorectal malignancy. Ann Plast Surg. 2010;64:559–62.

    CAS  PubMed  Google Scholar 

  19. Butler CE, Gündeslioglu AO, Rodriguez-Bigas MA. Outcomes of immediate vertical rectus abdominis myocutaneous flap reconstruction for irradiated abdominoperineal resection defects. J Am Coll Surg. 2008;206:694–703.

    Article  PubMed  Google Scholar 

  20. Chan S, Miller M, Ng R, Ross D, Roblin P, Carapeti E, et al. Use of myocutaneous flaps for perineal closure following abdominoperineal excision of the rectum for adenocarcinoma. Colorectal Dis. 2010;12:555–60.

    Article  CAS  PubMed  Google Scholar 

  21. Blok RD, Musters GD, Borstlap WAA, Buskens CJ, Bemelman WA, Tanis PJ, et al. Snapshot study on the value of omentoplasty in abdominoperineal resection with primary perineal closure for rectal cancer. Ann Surg Oncol. 2018;25:729–36.

    Article  PubMed  Google Scholar 

  22. Touny A, Othman H, Maamoon S, Ramzy S, Elmarakby H. Perineal reconstruction using pedicled vertical rectus abdominis myocutaneous flap (VRAM). J Surg Oncol. 2014;110:752–7.

    Article  PubMed  Google Scholar 

  23. Noguchi K, Nishizawa Y, Komai Y, Sakai Y, Kobayashi A, Ito M, et al. Efficacy of an additional flap operation in bladder-preserving surgery with radical prostatectomy and cystourethral anastomosis for rectal cancer involving the prostate. Surg Today. 2017;47:1119–28.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Chadi SA, Kidane B, Britto K, Brackstone M, Ott MC. Incisional negative pressure wound therapy decreases the frequency of postoperative perineal surgical site infections: a cohort study. Dis Colon Rectum. 2014;57:999–1006.

    Article  PubMed  Google Scholar 

  25. Wiegering A, Dietz UA, Corteville C, Plaßmeier L, Jurowich C, Germer C-T, et al. Impact of incisional negative pressure wound therapy on perineal wound healing after abdominoperineal rectum extirpation. Int J Colorectal Dis. 2017;32:291–3.

    Article  PubMed  Google Scholar 

  26. Hawkins AT, Berger DL, Shellito PC, Sylla P, Bordeianou L. Wound dehiscence after abdominoperineal resection for low rectal cancer is associated with decreased survival. Dis Colon Rectum. 2014;57:143–50.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Artioukh DY, Smith RA, Gokul K. Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma. Colorect Dis. 2007;9:362–7.

    Article  CAS  Google Scholar 

  28. Papaconstantinou HT, Bullard KM, Rothenberger DA, Madoff RD. Salvage abdominoperineal resection after failed Nigro protocol: modest success, major morbidity. Colorect Dis. 2006;8:124–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Ken Imaizumi, Yuji Nishizawa, Koji Ikeda, Yuichiro Tsukada, Takeshi Sasaki & Masaaki Ito

Authors
  1. Ken Imaizumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuji Nishizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koji Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuichiro Tsukada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takeshi Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masaaki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yuji Nishizawa or Masaaki Ito.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Imaizumi, K., Nishizawa, Y., Ikeda, K. et al. Extended pelvic resection for rectal and anal canal tumors is a significant risk factor for perineal wound infection: a retrospective cohort study. Surg Today 48, 978–985 (2018). https://doi.org/10.1007/s00595-018-1680-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-018-1680-5

Keywords

Search

Navigation