Article

Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure.

Department of Surgery, Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Diseases of the Colon & Rectum (impact factor: 3.13). 03/2005; 48(3):438-43. DOI:10.1007/s10350-004-0827-1
Source: PubMed

ABSTRACT Neoadjuvant radiation therapy has been used increasingly to downstage rectal cancer and decrease local recurrence. Despite its efficacy, preoperative radiation therapy may inhibit healing and contribute to wound complications. This study was designed to evaluate perineal wound complications after abdominoperineal resection.
The clinical records of a consecutive series of patients who underwent abdominoperineal resection for rectal carcinoma between 1988 and 2002 were reviewed. Demographic data, disease stage, and use of preoperative radiation therapy were recorded. Major wound complications included delayed wound healing (>1 month), wound infection requiring drainage/debridement, or reoperation.
A total of 160 patients underwent abdominoperineal resection with primary closure of the perineal wound (mean age, 63 +/- 12 years); 117 (73 percent) patients received preoperative radiation therapy; 114 received radiation therapy for rectal cancer (radiation therapy + chemotherapy = 107, radiation therapy alone = 7); 3 received radiation therapy for other pelvic malignancies. Median radiation dose was 5,040 (range, 900-5,400) cGY. Overall wound complication rate was 41 percent. Major wound complication rate was 35 percent. Delayed healing was the most common complication (24 percent), followed by infection (10 percent). Radiation therapy increased the risk of any wound complication (47 vs. 23 percent; P = 0.005), risk of a major wound complication (41 vs. 19 percent; P = 0.021), and risk of infection (14 vs. 0 percent; P = 0.015). Risk of wound complications did not correlate with age, gender, disease stage, smoking, or diabetes.
Wound complications are frequent after abdominoperineal resection and primary closure of the perineum. Preoperative radiation therapy doubles the rate of total and major perineal wound complications. Alternatives to primary perineal closure should be considered, particularly after radiation therapy.

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Keywords

abdominoperineal resection
 
clinical records
 
decrease local recurrence
 
Delayed healing
 
disease stage
 
downstage rectal cancer
 
major perineal wound complications
 
major wound complication
 
Major wound complications
 
Median radiation dose
 
perineal wound
 
perineal wound complications
 
preoperative radiation therapy
 
primary perineal closure
 
radiation therapy + chemotherapy
 
rectal cancer
 
rectal carcinoma
 
Wound complications
 
wound healing
 
wound infection