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

Imaizumi, Ken; Ikeda, Koji; Tsukada, Yuichiro; Sasaki, Takeshi; Ito, Masaaki

doi:10.1007/s00595-018-1680-5

Cited by 13 publications

(10 citation statements)

References 28 publications

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“…Various risk factors such as smoking [25][26][27] hypoalbuminemia [28], ASA classification [25] obesity [29], weight loss [25], the number of comorbidities [30,31] as a [27,29], neoadjuvant radiation therapy/chemoradiation therapy [27,32,33] as a tumor-related factor, flap reconstruction [26,27] and extralevator APR [34,35] as an operation-related factor are reported risk factors for PWC after APR. Generally, SSI risk factors, including a prolonged operation time, extensive bleeding, intraoperative blood transfusion and other risk factors related to surgery, are well known.…”

Section: Discussionmentioning

confidence: 99%

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

et al. 2020

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Background: Rectal amputation (RA) remains an important surgical procedure for salvage despite advances in sphincter-preserving resection, including intersphincteric resection. The aim of this study was to compare shortand long-term outcomes of RA with an initial perineal approach to those of RA with an initial abdominal approach (conventional abdominoperineal resection (APR)) for primary anorectal cancer. Methods:We retrospectively analyzed the short-and long-term outcomes of 48 patients who underwent RA with an initial perineal approach (perineal group) and 21 patients who underwent RA with an initial abdominal approach (conventional group).Results: For the perineal group, the operation time was shorter than that for the conventional group (313 vs. 388 min, p = 0.027). The postoperative complication rate was similar between the two groups (43.8 vs. 47.6%, p = 0.766). Perineal wound complications (PWCs) were significantly fewer in the perineal group than in the conventional group (22.9 vs. 57.1%, p = 0.006). All 69 patients underwent complete TME, but positive CRM was significantly higher in the conventional group than in the perineal group (0 vs. 19.0%, p = 0.011). There were no significant differences in the recurrence (43.8 vs. 47.6%, p = 0.689), 5-year disease-free survival (63.7% vs. 56.7%, p = 0.665) and 5-year overall survival rates (82.5% vs. 66.2%, p = 0.323) between the two groups. Conclusion: These data suggest that RA with an initial perineal approach for selective primary anorectal carcinoma is advantageous in minimizing PWCs and positive CRMs. Further investigations on the advantages of this approach are necessary.

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Section: Discussionmentioning

confidence: 99%

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

et al. 2020

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“…Various risk factors such as smoking [12 -14] hypoalbuminemia [15], ASA classification [16] obesity [17,18], weight loss [19], the number of comorbidities [20,21] as a patient-related factor, APR for recurrent cancer [22], neoadjuvant radiation therapy/chemoradiation therapy [23 -25] as a tumorrelated factor, flap reconstruction [26,27] and extralevator APR [28,29] as an operation-related factor are reported risk factors for PWC after APR. Generally, SSI risk factors, including a prolonged operation time, extensive bleeding, intraoperative blood transfusion and other risk factors related to surgery, are well known.…”

Section: Discussionmentioning

confidence: 99%

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

Funahashi

Goto

Kaneko

et al. 2019

Preprint

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Background: Rectal amputation (RA) remains an important surgical procedure for salvage despite advances in sphincter-preserving resection, including intersphincteric resection. The aim of this study was to compare short- and long-term outcomes of RA with an initial perineal approach to those of RA with an initial abdominal approach (conventional abdominoperineal resection (APR)) for primary anorectal cancer. Methods: We retrospectively analyzed the short- and long-term outcomes of 48 patients who underwent RA with an initial perineal approach (perineal group) and 21 patients who underwent RA with an initial abdominal approach (conventional group). Results: For the perineal group, the operation time was shorter than that for the conventional group (313 vs. 388 minutes, p = 0.027). The postoperative complication rate was similar between the two groups (43.8 vs. 47.6%, p = 0.766). Perineal wound complications (PWCs) were significantly fewer in the perineal group than in the conventional group (22.9 vs. 57.1%, p = 0.006). All 69 patients underwent complete TME, but positive CRM was significantly higher in the conventional group than in the perineal group (0 vs. 19.0%, p = 0.011). There were no significant differences in the recurrence (43.8 vs. 47.6%, p = 0.689), 5-year disease-free survival (63.7% vs. 56.7%, p = 0.665) and 5-year overall survival rates (82.5% vs. 66.2%, p = 0.323) between the two groups. Conclusion: These data suggest that RA with an initial perineal approach for selective primary anorectal carcinoma is advantageous in minimizing PWCs and positive CRMs. Further investigations on the advantages of this approach are necessary.

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“…However, how to effectively improve the healing of the perineal incision after APR or ELAPE and reduce the incidence of SSI is still a problem that plagues rectal cancer surgeons. 14 Scholars has also taken various efforts to reduce the incidence of SSI, mainly by reducing the dead space and preventing fluid accumulation, but the effects were not satisfactory. 15 Negative pressure drainage is considered to be an effective technique for the treatment of complex wounds such as severe fractures and soft tissue injuries.…”

Section: Introductionmentioning

confidence: 99%

Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

Han

Yang

Wang

et al. 2021

TCRM

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Purpose High rate of perineal surgical site infection (SSI) is the most common complication following abdominoperineal resection (APR), especially for extralevator abdominoperineal excision (ELAPE). The purpose of this study was to investigate the effect of continuous negative pressure drainage combined with intermittent irrigation (CNPDCII) in the presacral space on the perineal SSI following laparoscopic ELAPE for low rectal cancer. Patients and Methods The clinical data of 99 patients with low rectal cancer who underwent laparoscopic ELAPE surgery were retrospectively analyzed. Among the 99 patients, 46 patients received CNPDCII and 53 patients received conventional drainage in the presacral space after ELAPE. Self-made irrigation drainage tube: took a silicone drainage tube, cut 3 side holes at every 2cm intervals at the front end, and fixed a flexible tube of an intravenous needle at the front end of the silicone drainage tube. The conventional drainage tube or self-made irrigation drainage tube was placed in the presacral space and poked out from the inside of the ischial tuberosity. The incidence of SSI and other perioperative indicators between the two groups was compared within 30 days after surgery. Results There was no statistical difference in clinicopathological features between the two groups of patients (p>0.05). A statistically lower rate of SSI was found in CNPDCII group (17.4%, 8/46) than the conventional drainage group (35.8%, 19/53). The drainage tube retention time (7.8±1.2 d VS 9.4±1.6 d) and the postoperative hospital stay (9.7±1.4 d VS 11.9±2.3 d) in CNPDCII group were significantly shortened than the conventional drainage group. There was no statistical difference in operating theatre time and intraoperative blood loss between the two groups. Multivariate analysis confirmed that CNPDCII was an independent protective factor for SSI after ELAPE. Conclusion CNPDCII can effectively reduce the incidence of SSI following laparoscopic ELAPE, which is simple, safe and effective.

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

Abstract: 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.

Cited by 13 publications

References 28 publications

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

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