A Comparison of the Short-Term Outcomes of Three Flap Reconstruction Techniques Used After Beyond Total Mesorectal Excision Surgery for Anorectal Cancer

BACKGROUND: Surgery for advanced or recurrent pelvic malignancy can result in perineal defects that cannot be closed by wound edge approximation. Myocutaneous flaps can fill the defect and accelerate healing. No reconstruction has been proven to be superior to the others. OBJECTIVE: This study aimed to compare 3 flap procedures after beyond total mesorectal excision surgery. DESIGN: This is a retrospective analysis of a prospective database, according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. SETTINGS: This study was performed at a tertiary hospital. PATIENTS: Consecutive series of patients who required flap reconstruction after beyond total mesorectal excision surgery between 2007 and 2016 were included. MAIN OUTCOME MEASURES: Short-term outcomes after oblique rectus abdominis flap vs vertical rectus abdominis flap vs inferior gluteal artery perforator flap reconstruction were evaluated. RESULTS: Included are 65 (59%) oblique rectus abdominis flap, 30 (27.3%) vertical rectus abdominis flap, and 15 (13.7%) inferior gluteal artery perforator flap outcomes. Sacrectomy was performed in 12 (18.5%), 10 (33.3%), and 8 (53.3%) patients (p = 0.016). Preoperative radiotherapy was used in 60 (92.3%), 26 (86.7%), and 11 (73.3%) patients (p = 0.11). Flap infection and dehiscence occurred in 7 (10.8%), 1 (3.3%), and 4 (26.7%) patients. There was an increased risk of flap complication with inferior gluteal artery perforator flap vs vertical rectus abdominis flap (p = 0.036). Inferior gluteal artery perforator flap (OR, 6.26; p = 0.02) and obesity (OR, 4.96; p = 0.02) were associated with flap complications. Only complications of the oblique rectus abdominis flap decreased significantly over time (p = 0.03). The length of stay and complete (R0) resection rate were not different between the groups. LIMITATIONS: This study was limited because of its retrospective nature and because it was conducted at a single center. CONCLUSIONS: The techniques appear comparable. The approaches should be considered complementary, and the choice should be individualized. See Video Abstract at http://links.lww.com/DCR/B141. COMPARACION DE RESULTADOS A CORTO PLAZO DE TRES TECNICAS DE RECONSTRUCCION CON COLGAJO UTILIZADAS DESPUES DE LA CIRUGIA DE ESCISION MESORRECTAL TOTAL EXTENDIDA PARA EL CANCER ANORRECTAL: La cirugia para malignidad pelvica avanzada o recurrente puede provocar defectos perineales, que no pueden cerrarse por aproximacion de los bordes de la herida. Los colgajos miocutaneos pueden llenar el defecto y acelerar la curacion. Ninguna reconstruccion ha demostrado ser superior a las demas.Comparar tres procedimientos de colgajo despues de una cirugia de escision mesorrectal total extendida.Analisis retrospectivo de una base de datos prospectiva, de acuerdo con la Declaracion de Fortalecimiento de los informes de estudios observacionales en epidemiologia.Hospital de tercer nivel.Series consecutivas de pacientes que requirieron reconstruccion con colgajo despues de una cirugia de escision mesorrectal total extendida entre 2007 y 2016.Resultados a corto plazo despues del colgajo oblicuo recto abdominal versus colgajo vertical recto abdominal versus reconstruccion del colgajo perforador de la arteria glutea inferior.Se incluyen 65 (59%) colgajo oblicuo recto abdominal oblicuo, 30 (27.3%) colgajo vertical recto abdominal y 15 (13.7%) colgajo perforador de la arteria glutea inferior. Sacrectomia se realizo en 12 (18.5%), 10 (33.3%) y 8 (53.3%) pacientes respectivamente (p = 0.016). La radioterapia preoperatoria se utilizo en 60 (92.3%), 26 (86.7%) y 11 (73.3%) (p = 0,11). La infeccion del colgajo y la dehiscencia ocurrieron en 7 (10.8%), 1 (3.3%) y 4 (26.7%). Hubo un mayor riesgo de complicacion con el colgajo perforador de la arteria glutea inferior en comparacion al colgajo vertical del recto abdominal (p = 0.036). El colgajo perforador de la arteria glutea inferior (OR 6.26, p = 0.02) y la obesidad (OR 4.96, p = 0.02) se asociaron con complicaciones del colgajo. Solo las complicaciones del colgajo oblicuo recto abdominal disminuyeron significativamente con el tiempo (p = 0.03). La duracion de la estancia hospitalaria y la tasa de reseccion completa (R0) no fue diferente entre los grupos.Estudio retrospectivo en centro unico.Las tecnicas parecen comparables. Los enfoques deben considerarse complementarios y la eleccion individualizada. Consulte Video Resumen en http://links.lww.com/DCR/B141.