Immediate Reconstruction After Colorectal Cancer Resection

Abstract

Background Colorectal cancer is one of the most common and fatal malignancies in the United States. When localized to the distal gastrointestinal tract, surgical therapy includes abdominoperineal resection (APR) or pelvic exenteration (PEX). Subsequent ablative defects are considerable, impart concerning morbidity, and often necessitate autologous reconstruction. The aim of this study was to assess postoperative outcomes after reconstruction of APR and PEX defects. Methods The American College of Surgeons National Surgical Quality Improvement Program (2005–2017) was queried for patients undergoing APR for lower gastrointestinal malignancies with concurrent autologous reconstructions. Cases of disseminated cancer were excluded. Postoperative adverse event profiles, including rates of wound and systemic complications, were evaluated. Multivariate regression analysis controlling for age, sex, body mass index, and operative time was performed to calculate adjusted odds ratios (ORs). Results A total of 1309 patients were identified as undergoing APR/PEX with concomitant reconstruction. The majority (96.9%) of reconstructions consisted of muscle, myocutaneous, fasciocutaneous, or omental pedicled flaps. Of the cohort, 45.7% experienced at least 1 all-cause complication within 30-days of the procedure. Having a limited or moderate frailty (frailty index of “1” or “2”) was identified as a predictor of all-cause complications [OR, 1.556; 95% confidence interval (CI), 1.187–2.040, P = 0.001; and OR, 1.741; 95% CI, 1.193–2.541, P = 0.004, respectively], whereas smoking was a predictor of wound complications (OR, 1.462; 95% CI, 1.070–1.996, P = 0.017) and steroid use was a predictor of mild systemic complications (OR, 2.006; 95% CI, 1.058–3.805, P = 0.033). Conclusion Anorectal cancer resection often necessitates reconstruction secondary to postexenteration perineal defects. The incidence of postoperative complications is relatively high, and several risk factors are identified to help refine patient optimization.

Outcomes of the Composite Anterolateral Thigh Flap for Perineal Reconstruction After Postoncological Abdominoperineal Resection

“…For instance, a larger series on ablative surgeries described smoking as an independent risk factor for complications. 26 Analysis of more cases in the future might clarify the impact of smoking on healing time and incidence of complications.…”

A Case for the Use of the 5-Item Modified Frailty Index in Preoperative Risk Assessment for Tissue Expander Placement in Breast Reconstruction

“…1 The 5-factor modified frailty index (mFI-5) is a validated tool to assess frailty in preoperative patients and has been proven to be a good indicator of postoperative complications mortality and a fair indicator of 30-day hospital readmissions. This has been validated in multiple specialties such as general and orthopedic surgery [2][3][4][5] ; however, in the plastic surgery literature, there have been no studies that have looked at the association of mFI-5 with complications after breast reconstruction.…”

System-Level Determinants of Access to Flap Reconstruction after Abdominoperineal Resection

“…Even though the superiority of each method with regard to wound healing complications remains controversial in the literature, most studies demonstrate that attempts at primary closure following abdominoperineal resection are associated with high morbidity and complication rates. [1][2][3][4][5][6][7][8][9][10][11][12][13] Immediate flap reconstruction following abdominoperineal resection reduces the incidence of wound healing complications and fills dead-space created by tumor extirpation. 1,[4][5][6][7][8][9][10]12 More specifically, immediate flap reconstruction has been associated with lower rates of local…”

“…3,5,[7][8][9][10] Extant literature has focused on investigating patient outcomes after primary closure compared to flap reconstruction and identifying subsets of patients who benefit more from immediate flap reconstruction following abdominoperineal resection. [1][2][3][4][5][6][7][8][9][10][11][12][13] Other investigations have compared patient outcomes with different types of soft-tissue flaps in autologous reconstruction, with most studies demonstrating better outcomes with vertical rectus abdominis muscle flaps. [14][15][16][17][18][19][20][21][22][23][24][25][26] In a recent population-based analysis published by Billig et al, effective cost and resource use postoperatively at 6 months were found to be similar between patients who underwent abdominoperineal resection with immediate flap reconstruction in comparison to patients who underwent abdominoperineal resection alone, further supporting the utility of flap reconstruction after abdominoperineal resection in select patients and demonstrating that flap reconstruction is a judicious use of health care resources.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Immediate flap reconstruction following abdominoperineal resection reduces the incidence of wound healing complications and fills dead-space created by tumor extirpation. 1,[4][5][6][7][8][9][10]12 More specifically, immediate flap reconstruction has been associated with lower rates of local…”