PMID- 25064389
OWN - NLM
STAT- MEDLINE
DCOM- 20150420
LR  - 20220317
IS  - 1432-1262 (Electronic)
IS  - 0179-1958 (Linking)
VI  - 29
IP  - 9
DP  - 2014 Sep
TI  - Perineal wound healing after abdominoperineal resection for rectal cancer: a 
      two-centre experience in the era of intensified oncological treatment.
PG  - 1151-7
LID - 10.1007/s00384-014-1967-y [doi]
AB  - PURPOSE: Intensified treatment for distal rectal cancer has improved oncological 
      outcome, but at the expense of more perineal wound complications in patients 
      undergoing an abdominoperineal resection (APR). The aim of this study was to 
      analyse perineal wound healing after APR with primary perineal wound closure over 
      time. METHOD: All patients undergoing APR for primary rectal cancer with primary 
      wound closure between 2000 and 2013 were included and analysed in three 
      consecutive time periods. Both early (<30 days postoperatively) and late perineal 
      wound complications were determined. Independent risk factors of early perineal 
      wound complications were identified using multivariable analysis. RESULTS: A 
      total of 136 patients were identified, of whom 129 patients underwent primary 
      perineal wound closure. The use of neo-adjuvant (chemo)radiotherapy increased 
      from 72 to 91%, and the use of an extralevator approach increased from 9 to 19%. 
      The rate of early perineal wound complications increased from 18 to 31% and was 
      independently associated with an extralevator approach [odds ratio (OR) 3.17; 95% 
      confidence interval (CI) 1.16-8.66] and intra-operative perforation (OR 3.35; 95% 
      CI 1.06-10.57). Perineal wound complications had no impact on local recurrence or 
      3-year overall survival rate. During a median follow-up of 28 months 
      [interquartile range (IQR) 14-56], a persistent presacral sinus was diagnosed in 
      10%, and a perineal hernia occurred in 8% of the patients. CONCLUSION: 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.
FAU - Musters, Gijsbert D
AU  - Musters GD
AD  - Department of Surgery, Academic Medical Centre, University of Amsterdam, G4, Post 
      Box 22660, 1105 AZ, Amsterdam, The Netherlands.
FAU - Sloothaak, Didi A M
AU  - Sloothaak DA
FAU - Roodbeen, Sapho
AU  - Roodbeen S
FAU - van Geloven, Anna A W
AU  - van Geloven AA
FAU - Bemelman, Willem A
AU  - Bemelman WA
FAU - Tanis, Pieter J
AU  - Tanis PJ
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20140727
PL  - Germany
TA  - Int J Colorectal Dis
JT  - International journal of colorectal disease
JID - 8607899
SB  - IM
MH  - Abdomen/*surgery
MH  - Abscess/etiology
MH  - Aged
MH  - Chemoradiotherapy, Adjuvant
MH  - Female
MH  - Follow-Up Studies
MH  - Hernia/etiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neoadjuvant Therapy
MH  - Neoplasm Recurrence, Local
MH  - Neoplasm Staging
MH  - Perineum/injuries/*surgery
MH  - *Postoperative Complications
MH  - Rectal Neoplasms/mortality/pathology/*surgery
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Surgical Wound Dehiscence/etiology
MH  - Surgical Wound Infection/etiology
MH  - Survival Rate
MH  - *Wound Healing
EDAT- 2014/07/30 06:00
MHDA- 2015/04/22 06:00
CRDT- 2014/07/28 06:00
PHST- 2014/07/16 00:00 [accepted]
PHST- 2014/07/28 06:00 [entrez]
PHST- 2014/07/30 06:00 [pubmed]
PHST- 2015/04/22 06:00 [medline]
AID - 10.1007/s00384-014-1967-y [doi]
PST - ppublish
SO  - Int J Colorectal Dis. 2014 Sep;29(9):1151-7. doi: 10.1007/s00384-014-1967-y. Epub 
      2014 Jul 27.