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Perineal Wound Complications After Extralevator Abdominoperineal Excision for Low Rectal Cancer

Han, Jia Gang M.D.; Wang, Zhen Jun M.D.; Gao, Zhi Gang M.D.; Wei, Guang Hui M.D.; Yang, Yong M.D.; Zhai, Zhi Wei M.D.; Zhao, Bao Cheng M.D.; Yi, Bing Qiang M.D.

doi: 10.1097/DCR.0000000000001495
Original Contributions: Colorectal Cancer
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BACKGROUND: Reconstruction of the pelvic floor defect caused by extralevator abdominoperineal excision poses a challenge for the surgeon.

OBJECTIVE: The aim of this study was to analyze the long-term perineal wound complications in patients undergoing conventional primary closure versus biological mesh–assisted repair after extralevator abdominoperineal excision.

DESIGN: This was a single-institution retrospective observational study.

SETTINGS: The study was conducted at a tertiary academic medical center.

PATIENTS: Patients with low advanced rectal cancer undergoing extralevator abdominoperineal excision from August 2008 to December 2016 (N = 228) were included.

INTERVENTIONS: All of the patients received extralevator abdominoperineal excision operation.

MAIN OUTCOME MEASURES: The primary outcome measure was perineal wound complications after the operation.

RESULTS: Of the 228 patients who underwent extralevator abdominoperineal excision, 174 received biological mesh repair and 54 received primary closure. Preoperative radiotherapy was administered to 89 patients (51.1%) in the biological mesh group and 20 patients (37.0%) in the primary closure group. The biological mesh group had significantly lower rates of perineal wound infection (11.5% vs 22.2%; p = 0.047), perineal hernia (3.4% vs 13.0%; p = 0.022), wound dehiscence (0.6% vs 5.6%; p = 0.042), and total perineal wound complications (14.9% vs 35.2%; p = 0.001) compared with the primary closure group. Multivariable logistic regression analysis showed preoperative radiotherapy (p < 0.001), conventional primary closure (p < 0.001), and intraoperative bowel perforation (p= 0.001) to be significantly associated with perineal procedure–related complications.

LIMITATIONS: This was a single-center retrospective study.

CONCLUSIONS: Although perineal wound repair with biological mesh prolongs the operative time of perineal portion, the perineal drainage retention time, and the length of hospital stay, it may reduce perineal procedure–related complications and improve wound healing. Preoperative radiotherapy and intraoperative bowel perforation appear to be independent predictors of perineal complications. See Video Abstract at


La reconstrucción del defecto en el suelo pélvico, resultado de una resección abdominoperineal extra-elevadora plantea un desafío para el cirujano.


El analisis de las complicaciones de la herida perineal a largo plazo en pacientes sometidos a un cierre primario convencional versus una reparación asistida por malla biológica después de una resección abdominoperineal extra-elevadora.


Estudio retrospectivo observacional en una sola institución.


Investigación realizada en un centro médico académico terciario.


Se incluyeron los pacientes con cáncer rectal bajo avanzado que se sometieron a una resección abdominoperineal extra-elevadora desde agosto de 2008 hasta diciembre de 2016 (n= 228).


Todos aquellos pacientes que fueron sometidos a una resección abdominoperineal extra-elevadora.


Todas las complicaciones de la herida perineal en el postoperatorio.


De los 228 pacientes que se sometieron a una resección abdominoperineal extra-elevadora, 174 fueron reparados con una malla biológica y 54 se beneficiaron de un cierre primario. La radioterapia preoperatoria se administró a 89 (51,1%) pacientes en el grupo de malla biológica y 20 (37,0%) pacientes en el grupo de cierre primario. El grupo de malla biológica tuvo tasas significativamente más bajas de infección de la herida perineal (11.5% vs. 22.2%; p = 0.047), hernia perineal (3.4% vs. 13.0%; p = 0.022), dehiscencia de la herida (0.6% vs. 5.6%; p = 0,042) y complicaciones perineales de la herida (14,9% frente a 35,2%; p = 0,001) en comparación con el grupo de cierre primario. El análisis de regresión logística multivariable mostró que la radioterapia preoperatoria (p <0.001), el cierre primario convencional (p <0.001) y la perforación intestinal intra-operatoria (p = 0.001) se asociaron significativamente como complicaciones relacionadas con el procedimiento perineal.


Estudio retrospectivo de centro único.


Aunque la reparación de la herida perineal con malla biológica prolonga el tiempo perineal de la operación, la presencia y duración del drenaje perineal y la hospitalización pueden reducir las complicaciones relacionadas con el procedimiento perineal y mejorar la cicatrización de la herida. La radioterapia preoperatoria y la perforación intestinal intra-operatorias parecen ser predictores independientes de complicaciones perineales. Vea el Resumen del Video en

Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Funding/Support: This study was funded by the National High Technology Research and Development Program 863 of China (2015AA033602), the National Natural Science Foundation of China (81541101), the Capital Health Research and Development of Special (Z121107001012131 and 2018-1-2032), the Project of Beijing Chaoyang Hospital 1351 Talents Training (CYXZ-2017-09), and the Beijing Municipal Administration of Hospitals Incubating Program (PX2019012).

Financial Disclosure: None reported.

Presented at the meeting of the 13th Scientific and Annual Meeting of the European Society of Coloproctology, Nice, France, September 26 to 28, 2018.

Correspondence: Zhen Jun Wang, M.D., No. 8 Gongtinan Lu, Chaoyang District, Beijing, 100020 China. E-mail:

© The ASCRS 2019