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Risk factors for perineal wound complications following abdominoperineal resection

Caprice K Christian¹, Mary R Kwaan, Rebecca A Betensky

¹Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.

Diseases of the Colon and Rectum

|February 5, 2005

Abstract

Purpose:

Perineal wound complications are common following abdominoperineal resection. This study investigates the factors contributing to these complications.

Methods:

Patients undergoing abdominoperineal resection at our institution from June 1997 to May 2003 were reviewed. Significant predictors associated with minor (separation <2 cm, stitch abscesses, or sinus tracts) or major (>2 cm of separation, reoperation required, or readmission) wound complications were ascertained.

Results:

Of 153 patients, there were 22 major (14 percent) and 32 minor (24 percent) wound complications. Patients with anal cancer had a higher rate of major complications than those with rectal cancer or inflammatory bowel disease. Minor wound complications were more common in patients with anal cancer and inflammatory bowel disease than those with rectal cancer. Factors associated with a higher rate of major wound complications included flap closure, tumor size, body mass index, diabetes, and indication for the procedure. When the subset of patients with rectal cancer was considered, higher rates of major wounds were associated with increased body mass index, diabetes, and stage. Minor complications were associated with a two-team approach and increasing body mass index.

Conclusions:

This is currently the largest review of perineal wound complications following abdominoperineal resection. Patients with anal cancer and inflammatory bowel disease were at higher risk for perineal wound complications than those with rectal cancer. Preoperative radiation and primary closure were not associated with increased complications following abdominoperineal resection for rectal cancer.

Insights

Patients with anal cancer and inflammatory bowel disease face higher risks of perineal wound complications after abdominoperineal resection. Factors like flap closure and diabetes increase major complication rates.

Area of Science:

Surgical oncology
Colorectal surgery
Wound healing research

Background:

Perineal wound complications are a significant concern following abdominoperineal resection (APR).
Identifying risk factors is crucial for improving patient outcomes and reducing healthcare burdens.

Purpose of the Study:

To investigate the factors contributing to minor and major perineal wound complications after abdominoperineal resection.
To compare complication rates among different patient groups, including those with anal cancer, rectal cancer, and inflammatory bowel disease.

Main Methods:

Retrospective review of 153 patients who underwent abdominoperineal resection between June 1997 and May 2003.
Analysis of predictors for minor (e.g., separation <2 cm, stitch abscesses) and major (e.g., separation >2 cm, reoperation) wound complications.

Main Results:

Overall, 14% experienced major and 24% experienced minor complications.
Anal cancer and inflammatory bowel disease patients had higher rates of major and minor complications compared to rectal cancer patients.
Factors linked to major complications included flap closure, tumor size, BMI, diabetes, and procedure indication. For rectal cancer patients, increased BMI, diabetes, and stage were associated with major complications.

Conclusions:

Patients with anal cancer and inflammatory bowel disease are at increased risk for perineal wound complications post-APR.
Preoperative radiation and primary closure did not elevate complication rates in rectal cancer patients undergoing APR.

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