TY - JOUR
T1 - Wound dehiscence after abdominoperineal resection for low rectal cancer is associated with decreased survival
AU - Hawkins, Alexander T.
AU - Berger, David L.
AU - Shellito, Paul C.
AU - Sylla, Patrica
AU - Bordeianou, Liliana
PY - 2014/2
Y1 - 2014/2
N2 - Background: Abdominoperineal resection for low rectal adenocarcinoma is a common procedure with high morbidity, including perineal wound complications. Objective: The purpose of this study was to determine risk factors for perineal wound dehiscence and to investigate the effect of wound dehiscence on survival. Design: This was a retrospective medical chart review. Settings: The study was conducted in a tertiary care university medical center. Patients: Patients included in the study were those with low rectal adenocarcinoma who underwent abdominoperineal resection between January 2001 and June 2012. Main Outcomes Measures: We assessed the incidence of perineal wound dehiscence, as well as survival, after surgery. Results: A total of 249 patients underwent abdominoperineal resection for rectal carcinoma. The mean age was 62.6 years (range, 23.0-98.0 years), 159 (63.8%) were male, and the mean BMI was 27.9 (range, 16.7-58.5). There were 153 patients (61.1%) who survived for 5 years after surgery. Sixty-nine patients (27.7%) developed wound dehiscence. Multivariable analysis revealed the following associations with dehiscence: BMI (OR, 1.09; 95% CI, 1.03-1.15; p = 0.002), IBD (OR, 6.6; 95% CI, 1.4-32.5; p = 0.02), history of other malignant neoplasm (OR, 3.1; 95% CI, 1.5-6.6), and abdominoperineal resection for cancer recurrence (OR, 2.8; 95% CI, 1.2-6.3; p = 0.01). In the survival analysis, wound dehiscence was associated with decreased survival (mean survival time for dehiscence vs no dehiscence, 66.6 months vs 76.6 months; p = 0.01). This relationship persisted in the multivariable analysis (HR, 1.7; 95% CI, 1.1-2.8; p = 0.02). Limitations: This was a retrospective, observational study from a single center. Conclusions: The adjusted risk of death was 1.7 times higher in patients who experienced dehiscence than in those who did not. Attention to perineal wound closure with consideration of flap creation should at least be given to patients with a history of malignant neoplasm, those with IBD, those with rectal cancer recurrence, and women undergoing posterior vaginectomy. Preoperative weight loss should also reduce dehiscence risk.
AB - Background: Abdominoperineal resection for low rectal adenocarcinoma is a common procedure with high morbidity, including perineal wound complications. Objective: The purpose of this study was to determine risk factors for perineal wound dehiscence and to investigate the effect of wound dehiscence on survival. Design: This was a retrospective medical chart review. Settings: The study was conducted in a tertiary care university medical center. Patients: Patients included in the study were those with low rectal adenocarcinoma who underwent abdominoperineal resection between January 2001 and June 2012. Main Outcomes Measures: We assessed the incidence of perineal wound dehiscence, as well as survival, after surgery. Results: A total of 249 patients underwent abdominoperineal resection for rectal carcinoma. The mean age was 62.6 years (range, 23.0-98.0 years), 159 (63.8%) were male, and the mean BMI was 27.9 (range, 16.7-58.5). There were 153 patients (61.1%) who survived for 5 years after surgery. Sixty-nine patients (27.7%) developed wound dehiscence. Multivariable analysis revealed the following associations with dehiscence: BMI (OR, 1.09; 95% CI, 1.03-1.15; p = 0.002), IBD (OR, 6.6; 95% CI, 1.4-32.5; p = 0.02), history of other malignant neoplasm (OR, 3.1; 95% CI, 1.5-6.6), and abdominoperineal resection for cancer recurrence (OR, 2.8; 95% CI, 1.2-6.3; p = 0.01). In the survival analysis, wound dehiscence was associated with decreased survival (mean survival time for dehiscence vs no dehiscence, 66.6 months vs 76.6 months; p = 0.01). This relationship persisted in the multivariable analysis (HR, 1.7; 95% CI, 1.1-2.8; p = 0.02). Limitations: This was a retrospective, observational study from a single center. Conclusions: The adjusted risk of death was 1.7 times higher in patients who experienced dehiscence than in those who did not. Attention to perineal wound closure with consideration of flap creation should at least be given to patients with a history of malignant neoplasm, those with IBD, those with rectal cancer recurrence, and women undergoing posterior vaginectomy. Preoperative weight loss should also reduce dehiscence risk.
KW - Abdominoperineal resection
KW - Complication
KW - Dehiscence
KW - Rectal adenocarcinoma
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=84893774972&partnerID=8YFLogxK
U2 - 10.1097/DCR.0000000000000027
DO - 10.1097/DCR.0000000000000027
M3 - Article
C2 - 24401874
AN - SCOPUS:84893774972
SN - 0012-3706
VL - 57
SP - 143
EP - 150
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 2
ER -