A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer

Abstract

The objective of this systematic review and meta-analysis was to examine the effects of omentoplasty on pelviperineal morbidity following abdominoperineal resection (APR) in patients with cancer. Background: Recent studies have questioned the use of omentoplasty for the prevention of perineal wound complications. Methods: A systematic review of published literature since 2000 on the use of omentoplasty during APR for cancer was undertaken. The authors were requested to share their source patient data. Meta-analyses were conducted using a random-effects model. Results: Fourteen studies comprising 1894 patients (n ¼ 839 omentoplasty) were included. The majority had APR for rectal cancer (87%). Omentoplasty was not significantly associated with the risk of presacral abscess formation in the overall population (RR 1.11; 95% CI 0.79-1.56), nor in planned subgroup analysis (n ¼ 758) of APR with primary perineal closure for nonlocally advanced rectal cancer (RR 1.06; 95% CI 0.68-1.64). No overall differences were found for complicated perineal wound healing within 30 days (RR 1.30; 95% CI 0.92-1.82), chronic perineal sinus (RR 1.08; 95% CI 0.53-2.20), and pelviperineal complication necessitating reoperation (RR 1.06; 95% CI 0.80-1.42) as well. An increased risk of developing a perineal hernia was found for patients submitted to omentoplasty (RR 1.85; 95% CI 1.26-2.72). Complications related to the omentoplasty were reported in 4.6% (95% CI 2.5%-8.6%). Conclusions: This meta-analysis revealed no beneficial effect of omentoplasty on presacral abscess formation and perineal wound healing after APR, while it increases the likelihood of developing a perineal hernia. These findings do not support the routine use of omentoplasty in APR for cancer.

Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer

“…In the current pilot study with its small sample size, we found no distinct improvement in perineal wound healing rate compared to recent literature on various closure techniques after APR [2, 7, 19]. In addition, when compared to outcomes from our institution (and two other hospitals) after APR with primary layered closure and pedicled omentoplasty, we observe similar wound healing rates [20].…”

Clinical effectiveness of omental transposition in facilitating perineal wound healing after abdominoperineal resection: a systematic review

“…In a recently published meta-analysis, it was found that omental transposition had no effect on wound healing [ 30 ]. Moreover, this meta-analysis reported omental transposition-related complications.…”

CT assessment of the quality of omentoplasty and its implications for perineal wound healing

“…If the OP appears to be of poor quality on postoperative imaging-due to for example partial necrosis-the outcomes appear to be even worse than not performing an OP. Furthermore, the protective effect in preventing small bowel obstruction remains speculative, and there is likely an elevated risk of developing a perineal hernia after OP if considering recent literature [7][8][9].…”

“…Moreover, there seems a similar need for operative management of small Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-019-03412-0) contains supplementary material, which is available to authorized users. bowel obstruction and even an increased risk of perineal herniation in patients who have had OP [9].…”