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Wound Dehiscence After Abdominoperineal Resection for Low Rectal Cancer Is Associated With Decreased Survival

Hawkins, Alexander T. M.D., M.P.H.; Berger, David L. M.D.; Shellito, Paul C. M.D.; Sylla, Patrica M.D.; Bordeianou, Liliana M.D., M.P.H.

doi: 10.1097/DCR.0000000000000027
Original Contributions: Colorectal/Anal Neoplasia

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.

Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts

Funding/Support: Dr Hawkins was supported by a grant from the Brigham & Women’s Center for Surgery and Public Health Arthur Tracy Cabot Fellowship and the National Institutes of Health National Heart, Lung, and Blood Institute T32 (HL007734) Harvard/Longwood Vascular Surgery Training Program.

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: Liliana Bordeianou, M.D., M.P.H., Department of Surgery, Massachusetts General Hospital, 15 Parkman St, WAC-4–460, Boston, MA 02114-3117. E-mail: lbordeianou@partners.org

© 2014 The American Society of Colon and Rectal Surgeons