Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment

Musters, Gijsbert D.; Sloothaak, D.A.M.; Roodbeen, Sapho X; Geloven, A. A. W. van; Bemelman, Willem A.; Tanis, Pieter J.

doi:10.1007/s00384-014-1967-y

Cited by 44 publications

(47 citation statements)

References 27 publications

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“…All rights reserved. Gland Surg 2017;6(1):14-26 gs.amegroups.com complication type, agents used, and whether radiation was delivered preoperatively (6)(7)(8)(9)13,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Findings also vary between studies of the same organ ( Table 1) (6)(7)(8)(9)(10)(11)(12)37).…”

Section: Discussionmentioning

confidence: 99%

“…In some reports of organ sites other than breast, NAC was associated with increased transfusions, readmissions, SSI, stroke, and mortality (13,15,21,22,24,25). In other reports, NAC was not associated with any complication (13)(14)(15)(16)(17)(18)(19)(20)(21)23,25). Given this variability, our primary objective was to clarify the association between NAC and non-oncologic postoperative outcomes in patients undergoing breast surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the smaller number of patient encounters, single-institution reports of the effect of NAC on postoperative complications after breast surgery are more limited in their ability to distinguish differences in complications attributed to NAC (10)(11)(12). The association of NAC with morbidity and mortality (M&M) for organ sites other than breast has been reported many times (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), but these reports may not be relevant for breast patients. For example, patients undergoing breast surgery have lower overall M&M but higher reoperation rates compared with most other general surgical oncology operations (27)(28)(29).…”

Section: Original Articlementioning

confidence: 99%

See 2 more Smart Citations

Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

Landercasper¹,

Bennie²,

Bray³

et al. 2017

Gland Surg.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

See 1 more Smart Citation

Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

Landercasper¹,

Bennie²,

Bray³

et al. 2017

Gland Surg.

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“…Moreover, one third of patients after PE will develop perineal wound dehiscence[38]. As a corollary, persistent presacral sinus was found in 10% of the patients following APR[39]. …”

Section: Current Statusmentioning

confidence: 99%

Biological mesh reconstruction of the pelvic floor following abdominoperineal excision for cancer: A review

Schiltz¹,

Buchs²,

Penna³

et al. 2017

WJCO

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Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal wounds. Such large wounds are prone to infection and perineal herniation, and their closure is a major concern to most surgeons. Different approaches to the perineal repair exist, varying from primary or mesh closure to myocutaneous flaps. Each technique has its own associated advantages and potential complications and the ideal approach is still debated. In the present study, we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound closure. Current evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap reconstruction. In addition, the rate of perineal hernia is lower in early follow-up, while long-term hernia occurrence appears to be similar between the different techniques. Finally, it is an easy and quick reconstruction method. Although more expensive than primary closure, the cost associated with the use of a biological mesh is at least equal, if not less, than flap reconstruction.

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“…There is already much research published on the risk factors for perineal wound complications, which can be divided into preoperative and intraoperative factors. Postulated preoperative risk factors include elevated body mass index (BMI), diabetes, patient comorbidities (cardiopulmonary, renal, or hepatic), the indication for procedure, and preoperative radiation therapy . Proposed intraoperative risk factors include extra‐levator abdominoperineal excision (ELAPE), concomitant posterior vaginectomy, supine patient positioning, blood loss, and surgical drain placement …”

Section: Introductionmentioning

confidence: 99%

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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Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment

Abstract: The increased use of an extralevator APR for rectal cancer significantly increased the risk of perineal wound complications over time. Intra-operative perforation was also independently associated with impaired perineal wound healing.

Cited by 44 publications

References 27 publications

Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

Biological mesh reconstruction of the pelvic floor following abdominoperineal excision for cancer: A review

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

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