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Vertical Rectus Abdominis Musculocutaneous Flap Repair Improves Perineal Wound Healing after Abdominoperineal Resection for Irradiated Locally Advanced Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Radiotherapy (RT) and subsequent abdominoperineal resection (APR) for locally advanced rectal cancer (LARC) is associated with significant perineal wound morbidity. The aim of the present study was to investigate if vertical rectus abdominis musculocutaneous (VRAM) flap repair after APR in LARC patients improves perineal wound healing compared with direct perineal wound closure (non-VRAM).

Methods

LARC patients (n = 329) operated with APR between January 2006 and December 2015 after neoadjuvant RT of ≥ 25 Gy were identified, including 260 and 69 patients in the non-VRAM and VRAM groups, respectively. Perineal wound healing was assessed 3 months postoperatively, and risk factors for perineal wound complications and associations with short- and long-term outcome were analyzed.

Results

Delayed perineal wound healing after 3 months was more frequent in the non-VRAM group (31.5%) compared with the VRAM group (10.4%) (p < 0.01). In the non-VRAM group, 26.9% of patients developed pelvic abscess, compared with 10.1% in the VRAM group (p < 0.01). Significant risk factors for perineal wound morbidity were non-VRAM (odds ratio [OR] 3.94, 95% confidence interval [CI] 1.72–9.00; p = 0.02), positive circumferential resection margin (R1; OR 3.64, 95% CI 1.91–6.93; p < 0.01), pelvic abscess (OR 3.27, 95% CI 1.90–5.63; p < 0.01), and short-course RT (OR 3.81, 95% CI 1.75–8.30; p < 0.01). Perineal wound morbidity was not associated with impaired long-term oncologic outcome.

Conclusions

VRAM flap reconstruction of the perineum is associated with an increased wound healing rate and may protect against pelvic abscess development. However, procedure-related long-term morbidity is incompletely studied and the procedure should be reserved for selected patients.

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Acknowledgements

The authors would like to thank the staff at the Department of Gastroenterological Surgery, and Veronica M. Alexandersen, for their invaluable contributions to this work.

Funding

The authors declare no relevant financial relationships.

Disclosures

Milan Spasojevic, Anthony B. Mariathasan, Mariusz Goscinski, Ebbe B. Thorgersen, Arne M. Solbakken, Hans-Petter Gullestad, Truls Ryder, Kjersti Flatmark, and Stein G. Larsen declare no conflicts of interest.

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Author notes

  1. Kjersti Flatmark and Stein G. Larsen contributed equally to this study.

Authors and Affiliations

  1. Department of Gastroenterological Surgery, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

    Milan Spasojevic MD, PhD, Anthony B. Mariathasan MD, Mariusz Goscinski MD, PhD, Ebbe B. Thorgersen MD, PhD, Arne M. Solbakken MD, Kjersti Flatmark MD, PhD & Stein G. Larsen MD, PhD

  2. Department of Plastic Surgery, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

    Hans-Petter Gullestad MD & Truls Ryder MD

  3. Department of Tumor Biology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

    Kjersti Flatmark MD, PhD

  4. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Kjersti Flatmark MD, PhD

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  1. Milan Spasojevic MD, PhD
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Correspondence to Milan Spasojevic MD, PhD.

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Spasojevic, M., Mariathasan, A.B., Goscinski, M. et al. Vertical Rectus Abdominis Musculocutaneous Flap Repair Improves Perineal Wound Healing after Abdominoperineal Resection for Irradiated Locally Advanced Rectal Cancer. Ann Surg Oncol 25, 1357–1365 (2018). https://doi.org/10.1245/s10434-018-6363-3

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