Omentoplasty in Patients Undergoing Abdominoperineal Resection After Long-Course Chemoradiation for Locally Advanced and Locally Recurrent Rectal Cancer: A Comparative Single-Institution Cohort Study

Abstract

BACKGROUND: Omentoplasty is a commonly performed procedure after abdominoperineal resection for rectal cancer, but its effectiveness to reduce pelviperineal complications is not firmly established. OBJECTIVE: This study aimed to assess the impact of omentoplasty on postoperative outcomes after long-course (chemo) radiotherapy and abdominoperineal resection in patients with locally advanced and locally recurrent rectal cancer. DESIGN: Retrospective cohort study. SETTINGS: Single center. PATIENTS: All patients with locally advanced and locally recurrent rectal cancer undergoing abdominoperineal resection after neoadjuvant (chemo)radiation in a tertiary referral center between 2008 and 2020 were retrospectively reviewed. MAIN OUTCOME MEASURES: Multivariable logistic and linear regression analyses were performed to analyze the association between omentoplasty and pelviperineal complications, duration of nasogastric tube drainage, and length of hospital stay. RESULTS: A total of 305 patients were analyzed, of whom 245 underwent omentoplasty (80%). Pelviperineal complications occurred in 151 patients (50%) overall, in 125 patients (51%) with omentoplasty, and in 26 patients (43%) without omentoplasty. Independent predictors of pelviperineal complications in multivariable analyses were smoking (OR 2.68; 95% CI, 1.46–4.94) and high BMI (OR 1.68; 95% CI, 1.00–2.83), but not omentoplasty (OR 1.36; 95% CI, 0.77–2.40). The mean duration of nasogastric tube drainage was longer after omentoplasty (6 vs 4 d) with a significant association in multivariable analysis (β coefficient 1.97; 95% CI, 0.35–3.59). Patients undergoing omentoplasty had a significantly longer hospital stay (14 vs 10 d), and omentoplasty remained associated with a prolonged hospital stay after adjusting for confounding (β coefficient 3.05; 95% CI, 0.05–5.74). LIMITATIONS: Retrospective design. CONCLUSION: Omentoplasty was not associated with a reduced risk of the occurrence of short-term pelviperineal complications after abdominoperineal resection in patients undergoing long-course (chemo)radiotherapy. Furthermore, in patients undergoing omentoplasty, prolonged duration of nasogastric tube drainage and hospital stay was observed. See Video Abstract at http://links.lww.com/DCR/C124. OMENTOPLASTIA EN PACIENTES SOMETIDOS A RESECCIÓN ABDOMINOPERINEAL DESPUÉS DE QUIMIORRADIOTERAPIA DE CURSO LARGO PARA EL CÁNCER DE RECTO LOCALMENTE AVANZADO Y LOCALMENTE RECURRENTE: ESTUDIO DE COHORTE COMPARATIVO DE UNA SOLA INSTITUCIÓN ANTECEDENTES: La omentoplastía es un procedimiento que se realiza comúnmente después de la resección abdominoperineal por cáncer de recto, pero su efectividad para reducir las complicaciones pelvicoperineales no está firmemente establecida. OBJETIVO: Evaluar el impacto de la omentoplastía en las complicaciones pelvicoperineales a corto plazo y los resultados postoperatorios después quimioradioterapia de curso largo y resección abdominoperineal en pacientes con cáncer de recto localmente avanzado y localmente recurrente. DISEÑO: Es...

The effect of omentoplasty in various surgical operations: Systematic review and meta-analysis

“…Although the impact of omentoplasty on surgical procedures has been extensively studied 3 – 8 , 13 , there is a lack of comprehensive studies that summarize all procedures and conduct subgroup analyses based on age and BMI. Both factors have significant implications for various postoperative outcomes 108 – 112 , necessitating further subgroup analysis to inform clinical decision-making. This is the first investigation into the current utilization of omentoplasty across a spectrum of procedures.…”

Median and medial umbilical ligament repositioning for prevention of pelviperineal complications following abdominoperineal resection—a case series and novel technique

“…Recent studies also show that it does not reduce the rates of small bowel obstruction and perineal complications. [13], [18].…”

“…However, all of these have limitations in terms of technical considerations, costs, operative times, and issues related to the placement of foreign bodies like prostheses, meshes, and balloons. Moreover, the success rates with the available techniques are far from satisfactory, and there seldom resulted in frightful complications [7], [8], [10]- [13]. Moreover, the risk of perineal wound complications like infection, dehiscence, and delayed healing following abdominoperineal resection ranges from 14% to 80 % [14], [15] To mitigate many of the concerns with the available methods, we propose using a partially mobilised urinary bladder with umbilical ligaments hitched to the pelvic inlet as an effective barrier to avoid the descent of the small bowel into the low pelvis.…”

Rectal Cancer: New Challenges

“…Van Campenhout et al 16 reported a single-center study to assess the effect of "omentoplasty" on the incidence of pelvic and perineal complications following long-course neoadjuvant chemoradiation for LARC and abdominoperineal resection. Ingwersen et al 17 used data from the 2011-2020 Dutch Colorectal Audit to assess the declining use of diverting stomas in rectal cancer surgery and the impact on anastomotic leak.…”