Perineal Wound Complications After Extralevator Abdominoperineal Excision for Low Rectal Cancer

BACKGROUND: Reconstruction of the pelvic floor defect caused by extralevator abdominoperineal excision poses a challenge for the surgeon. OBJECTIVE: The aim of this study was to analyze the long-term perineal wound complications in patients undergoing conventional primary closure versus biological mesh-assisted repair after extralevator abdominoperineal excision. DESIGN: This was a single-institution retrospective observational study. SETTINGS: The study was conducted at a tertiary academic medical center. PATIENTS: Patients with low advanced rectal cancer undergoing extralevator abdominoperineal excision from August 2008 to December 2016 (N = 228) were included. INTERVENTIONS: All of the patients received extralevator abdominoperineal excision operation. MAIN OUTCOME MEASURES: The primary outcome measure was perineal wound complications after the operation. RESULTS: Of the 228 patients who underwent extralevator abdominoperineal excision, 174 received biological mesh repair and 54 received primary closure. Preoperative radiotherapy was administered to 89 patients (51.1%) in the biological mesh group and 20 patients (37.0%) in the primary closure group. The biological mesh group had significantly lower rates of perineal wound infection (11.5% vs 22.2%; p = 0.047), perineal hernia (3.4% vs 13.0%; p = 0.022), wound dehiscence (0.6% vs 5.6%; p = 0.042), and total perineal wound complications (14.9% vs 35.2%; p = 0.001) compared with the primary closure group. Multivariable logistic regression analysis showed preoperative radiotherapy (p < 0.001), conventional primary closure (p < 0.001), and intraoperative bowel perforation (p= 0.001) to be significantly associated with perineal procedure-related complications. LIMITATIONS: This was a single-center retrospective study. CONCLUSIONS: Although perineal wound repair with biological mesh prolongs the operative time of perineal portion, the perineal drainage retention time, and the length of hospital stay, it may reduce perineal procedure-related complications and improve wound healing. Preoperative radiotherapy and intraoperative bowel perforation appear to be independent predictors of perineal complications. See Video Abstract at http://links.lww.com/DCR/B42. COMPLICACIONES DE LA HERIDA PERINEAL DESPUES DE LA EXCISION ABDOMINOPERINEAL EXTRA-ELEVADORA EN CASO DE CANCER DE RECTO BAJO: La reconstruccion del defecto en el suelo pelvico, resultado de una reseccion abdominoperineal extra-elevadora plantea un desafio para el cirujano.El analisis de las complicaciones de la herida perineal a largo plazo en pacientes sometidos a un cierre primario convencional versus una reparacion asistida por malla biologica despues de una reseccion abdominoperineal extra-elevadora.Estudio retrospectivo observacional en una sola institucion.Investigacion realizada en un centro medico academico terciario.Se incluyeron los pacientes con cancer rectal bajo avanzado que se sometieron a una reseccion abdominoperineal extra-elevadora desde agosto de 2008 hasta diciembre de 2016 (n= 228).Todos aquellos pacientes que fueron sometidos a una reseccion abdominoperineal extra-elevadora.Todas las complicaciones de la herida perineal en el postoperatorio.De los 228 pacientes que se sometieron a una reseccion abdominoperineal extra-elevadora, 174 fueron reparados con una malla biologica y 54 se beneficiaron de un cierre primario. La radioterapia preoperatoria se administro a 89 (51,1%) pacientes en el grupo de malla biologica y 20 (37,0%) pacientes en el grupo de cierre primario. El grupo de malla biologica tuvo tasas significativamente mas bajas de infeccion de la herida perineal (11.5% vs. 22.2%; p = 0.047), hernia perineal (3.4% vs. 13.0%; p = 0.022), dehiscencia de la herida (0.6% vs. 5.6%; p = 0,042) y complicaciones perineales de la herida (14,9% frente a 35,2%; p = 0,001) en comparacion con el grupo de cierre primario. El analisis de regresion logistica multivariable mostro que la radioterapia preoperatoria (p <0.001), el cierre primario convencional (p <0.001) y la perforacion intestinal intra-operatoria (p = 0.001) se asociaron significativamente como complicaciones relacionadas con el procedimiento perineal.Estudio retrospectivo de centro unico.Aunque la reparacion de la herida perineal con malla biologica prolonga el tiempo perineal de la operacion, la presencia y duracion del drenaje perineal y la hospitalizacion pueden reducir las complicaciones relacionadas con el procedimiento perineal y mejorar la cicatrizacion de la herida. La radioterapia preoperatoria y la perforacion intestinal intra-operatorias parecen ser predictores independientes de complicaciones perineales. Vea el Resumen del Video en http://links.lww.com/DCR/B42.