Impact of Flap Reconstruction on Perineal Wound Complications Following Ablative Surgery for Advanced and Recurrent Rectal Cancers

Davidge, Kristen M.; Raghuram, Kamini; Hofer, Stefan O. P.; Ferguson, Peter C.; Wunder, Jay S.; Swallow, Carol J.; Zhong, Toni

doi:10.1245/s10434-014-3529-5

Cited by 35 publications

(36 citation statements)

References 20 publications

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“…46 To reduce the risk of postoperative infection and wound complications, we recommend the use of a vertical rectus abdominis flap to reconstruct the posterior soft-tissue defect in the pelvic floor. [47][48][49] There are several limitations to this study. The retrospective nature of the study limits the data we were able to collect and contains constraints on the analysis presented.…”

Section: Overall and Disease-specific Survivalmentioning

confidence: 98%

Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma

Houdek

Rose

Hevesi

et al. 2019

Journal of Surgical Oncology

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Background We reviewed the disease control and complications of the treatment of sacrococcygeal chordoma from four tertiary cancer centers with emphasis on the effects of radiotherapy in surgically treated patients. Methods A total of 193 patients with primary sacrococcygeal chordoma from 1990 to 2015 were reviewed. There were 124 males, with a mean age of 59 ± 15 years and a mean follow‐up of 7 ± 4 years. Eighty‐nine patients received radiotherapy with a mean total dose of 61.8 ± 10.9 Gy. Results The 10‐year disease‐free and disease‐specific survival was 58% and 72%, respectively. Radiation was not associated with local recurrence (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.59‐2.17; P = 0.71), metastases (HR, 0.93; 95% CI, 0.45‐1.91; P = 0.85) or disease‐specific survival (HR, 0.96; 95% CI, 0.46‐2.00; P = 0.91). Higher doses (≥70 Gy; HR, 0.52; 95% CI, 0.20‐1.32; P = 0.17) may be associated with reduced local recurrence. Radiotherapy was associated with wound complications (HR, 2.76; 95% CI, 1.64‐4.82;, P < 0.001) and sacral stress fractures (HR, 4.73; 95% CI, 1.88‐14.38; P < 0.001). Conclusions In this multicenter review, radiotherapy was not associated with tumor outcome but associated with complications. The routine use of radiotherapy with en‐bloc resection of sacrococcygeal chordomas should be reconsidered in favor of a selective, individualized approach with a radiation dose of ≥70 Gy.

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Section: Overall and Disease-specific Survivalmentioning

confidence: 98%

Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma

Houdek

Rose

Hevesi

et al. 2019

Journal of Surgical Oncology

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“…Amongst these studies, 118 studies were excluded for the following reasons: one animal study; four studies included other tumour types; 49 studies just reported one surgical regimen or technical material; 17 studies were reviews, letters, editorials; 11 studies lacked full text or data; nine studies were non-English articles; 27 studies were case reports. Finally, 18 studies including one RCT and 17 cohort studies published between 1948 and 2017 were included in this systematic review and meta-analysis [8,11,14,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40].…”

Section: Literature Search and Study Selectionmentioning

confidence: 99%

“…Additionally, for the overall population, there were 1990 patients (12.17%) receiving preoperative radiotherapy in the primary closure group and 425 patients (27.12%) in the myocutaneous flap closure group, with a significant difference between the two groups. Among these included studies, one performed the propensity matching analysis, four matched BMI, 12 matched comorbidities and six matched preoperative radiotherapy [8,[26][27][28][29][30][31][32][33][34][36][37][38][39][40]. Nine studies on stage of cancer had the following distribution: low tumour stage (I-II) (252 cases in primary closure, 1.54%; 101 cases in myocutaneous flap closure, 6.45%) and advanced tumour stage (III-IV) (312 cases in primary closure, 1.91%; 124 cases in myocutaneous flap closure, 7.91%) [8,26,28,30,[32][33][34]38,39].…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…The methodological quality assessment of prospective/ retrospective cohort studies and RCTs is shown in Table 2. Of the 18 cohort studies, 16 had high quality with five or more stars [8,11,[26][27][28][29][30][31][32][33][34][35][36][37]39,40]. The only RCT study had high quality with a score of 5 and a low risk of bias according to the Cochrane criteria [38].…”

Section: Quality Judgement Of Studiesmentioning

confidence: 99%

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Primary vs myocutaneous flap closure of perineal defects following abdominoperineal resection for colorectal disease: a systematic review and meta‐analysis

Wei

Yang

et al. 2019

Colorectal Disease

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Aim Perineal wound complications after abdominoperineal resection (APR) have become a major clinical challenge. Myocutaneous flap closure has been proposed in place of primary closure to improve wound healing. We conducted this comprehensive meta‐analysis to evaluate the current scientific evidence of primary closure vs myocutaneous flap closure of perineal defects following APR for colorectal disease. Methods We systematically searched the MEDLINE, Embase, PubMed, Web of Science and Cochrane Library databases to identify all relevant studies. After data extraction from the included studies, meta‐analysis was performed to compare perioperative outcomes of primary closure and myocutaneous flap closure. Results Eighteen studies with a total of 17 913 patients (16 346 primary closure vs 1567 myocutaneous flap closure) were included. We found that primary closure was significantly associated with higher total perineal wound complications (P = 0.007), major perineal wound complications (P < 0.001) and perineal wound infection (P = 0.001). On the other hand, myocutaneous flap closure takes more operation time (P < 0.001) and increases the risk of perineal wound dehiscence (P = 0.01), deep surgical site infection (P < 0.001), enterocutaneous fistulas (P = 0.03) and return to the operating room (P = 0.0005). There were no significant differences between the two groups for other outcomes. Conclusions This is the first systematic review with meta‐analysis comparing primary closure with myocutaneous flap closure of perineal defects after APR for colorectal disease. Although taking more operation time and an increased risk of specific complications, the pooled results have validated the use of myocutaneous flaps for reducing total/major perineal wound complications. More investigations are needed to draw definitive conclusions on this dilemma.

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“…Flap closures have been proposed as a way to improve perineal wound healing, but their benefit has been controversial. Some prospective studies demonstrated a protective effect of flap closure for APRs and pelvic exenterations, while other studies found limited evidence for them . Overall, the current literature suggests that flap reconstruction may be useful in certain patients and should be selectively used based on the size of the perineal defect.…”

Section: Introductionmentioning

confidence: 98%

The application of incisional negative pressure wound therapy for perineal wounds: A systematic review

Cahill

Fowler

Williams

2018

International Wound Journal

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Impaired perineal wound healing is a major source of morbidity after abdominoperineal resection. Incisional negative pressure wound therapy can improve healing, prevent infections, and decrease the frequency of dehiscence. Our objective was to summarise existing evidence on the use of incisional negative pressure wound therapy on perineal wounds after abdominoperineal resection and to determine the effect on perineal wound complications. Electronic databases were searched in January 2017. Studies describing the use of incisional negative pressure wound therapy on primarily closed perineal wounds after abdominoperineal resection were included. Of the 278 identified articles, 5 were retrieved for inclusion in the systematic review (n = 169 patients). A significant decrease in perineal wound complications when using incisional negative pressure wound therapy was demonstrated, with surgical site infection rates as low as 9% (vs 41% in control groups). The major limitation of this systematic review was a small number of retrieved studies with small patient populations, high heterogeneity, and methodological issues. This review suggests that incisional negative pressure wound therapy decreases perineal wound complications after abdominoperineal resection. Further prospective trials with larger patient populations would be needed to confirm this association and delineate which patients might benefit most from the intervention.

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Impact of Flap Reconstruction on Perineal Wound Complications Following Ablative Surgery for Advanced and Recurrent Rectal Cancers

Cited by 35 publications

References 20 publications

Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma

Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma

Primary vs myocutaneous flap closure of perineal defects following abdominoperineal resection for colorectal disease: a systematic review and meta‐analysis

The application of incisional negative pressure wound therapy for perineal wounds: A systematic review

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