Comparison of Perineal Closure Techniques after Abdominoperineal Resections for Carcinoma of the Anus

Abstract

Background Perineal reconstruction following salvage APR’s for squamous cell carcinoma of the anus (SCCA) are scant with conflicting results from large and single center studies. We analyzed these techniques taking into account sociodemographic and oncologic variables. Methods This is a retrospective cohort study from 2016-2019 using a targeted ACS/NSQIP database stratified into primary closure (PC), abdominal myocutaneous (AM), lower extremity (LE), and omental pedicled (OP) flaps. We analyzed major and wound complications through univariate and multivariate regression analysis. Results A total of 766 patients were analyzed, 512 (67%) had PC, 196 (25%) AM, 36 (5%) OP and 22 (3%) LE. Rates of chemotherapy and radiation within 90 days were similar between the groups. Having 2 or more additional organs resected was more common for the AM group (AM 4.1%, PC 1.6%, OP 3.3%, LE 0%). Overall, major complication rate was 41% (n = 324). Primary closure had 35.0%, OP 47.2%, AM 52.6%, and LE 45.5%. Wound complication rate was highest in AM with 11.7%, followed by OP 8.3%, PC 5.9%, and LE 0%. The multivariate regression analysis demonstrated none of the closure techniques to be associated with increasing or decreasing the probability of having a major or wound complication. Morbidity probability was the sole predictor of major complication (OR 1.07, 95% CI 1.04-1.1) Conclusions Myocutaneous and omental flaps are associated with comparable wound and major complications when taking into account the baseline, oncologic and perioperative variables that drive the clinical decision making when selecting a perineal reconstruction.

Perineal wound complications after vertical rectus abdominis myocutaneous flap and mesh closure following abdominoperineal surgery and pelvic exenteration of anal and rectal cancers: A meta‐analysis

“…Of the 20 papers, published between 2005 and 2023, from a total of 2008 linked to research that met the inclusion criteria were chosen for the research 13–32 . The consequences of these investigations are accessible in Table 2.…”

“…Of the 20 papers, published between 2005 and 2023, from a total of 2008 linked to research that met the inclusion criteria were chosen for the research. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The consequences of these investigations are accessible in Table 2. 2972 AS and PE of anal and rectal cancers persons were in the utilized researchers' starting point, 1216 of them were utilizing VRAM flap, and 1756 were PC.…”

“…In the research that was utilized for the meta‐analysis, 2972 AS and PE of anal and rectal cancers persons were in the utilized researchers' starting point, 1216 of them were utilizing VRAM flap, and 1756 were PC 13–32 . VRAM flap had significantly lower PWCs, and major PWCs compared to PC in AS and PE of anal and rectal cancers persons.…”

“…In the research that was utilized for the meta-analysis, 2972 AS and PE of anal and rectal cancers persons were in the utilized researchers' starting point, 1216 of them were utilizing VRAM flap, and 1756 were PC. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] VRAM flap had significantly lower PWCs, and major PWCs compared to PC in AS and PE of anal and rectal cancers persons. However, VRAM flap and PC had no significant difference in minor PWCs in AS and PE of anal and rectal cancer persons.…”