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Short- and mid-term outcomes of abdominoperineal resection with perineal mesh insertion: a single-centre experience
Ahmed Gendia1, Masood Rehman2, Cindy W Lin2
1Colorectal Department, Northampton University Hospital, Northampton, NN1 5BD, UK. ahmed.gendia@nhs.net.
Insights
Biological mesh closure after abdominoperineal resection (APR) for low rectal cancer shows favorable short-term outcomes. This technique helps manage challenging perineal wounds, reducing complications like hernias and improving overall survival.
Area of Science:
- Surgical Oncology
- Colorectal Surgery
- Wound Management
Background:
- Abdominoperineal resection (APR) is crucial for low rectal/anorectal cancers.
- Perineal wound closure, especially after extralevator APR (ELAPR), presents significant challenges due to tissue gaps.
- Various methods are explored to enhance perineal wound repair outcomes.
Purpose of the Study:
- To evaluate the 6-year experience with biological mesh for perineal wound closure following APR.
- To assess the efficacy and safety of biological mesh in managing complex perineal defects.
Main Methods:
- Retrospective analysis of a prospectively maintained database from 2016-2021.
- Inclusion of patients who underwent APR with perineal mesh closure.
- Data collection on patient demographics, surgical approach, neoadjuvant therapy, outcomes, and follow-up.
Main Results:
- 49 patients underwent APR with perineal mesh reconstruction; 63% male, mean age 68, mean BMI 27.9.
- 30% perineal wound infection rate; 4.1% perineal hernia rate.
- 91% overall survival; 18.3% disease recurrence rate over a mean follow-up of 29.2 months.
Conclusions:
- Routine use of biological mesh for perineal wound closure after APR demonstrates favorable short- and medium-term outcomes.
- The technique appears effective in managing complex perineal defects, contributing to good oncological and survival results.
Purpose:
Abdominoperineal resection (APR) remains a key procedure for the treatment of low rectal/anorectal cancers. However, perineal wound closure remains challenging, particularly in extralevator abdominoperineal resection (ELAPR) due to gapped tissue planes. Different approaches have been attempted to improve perineal wound repair. The aim of this study is to report our 6-year experience in perineal wound closure utilising biological mesh.
Methods:
We conducted a retrospective study using data from our prospectively maintained database, including patients who underwent APR with perineal mesh closure between 2016 and 2021.
Results:
49 patients underwent APR with perineal mesh reconstruction for low rectal cancer during the 6-year period. Of these, 63% were males, with a mean age of 68 (± 11), and a mean BMI of 27.9 (± 13.7). 49% (24) of patients received neoadjuvant therapy. 88% (43) of patients underwent standard "S-APR" and only 12% (6) underwent ELAPR. Majority of procedures were laparoscopic (87.8%) with conversion rate of 6.9%. Mean length of stay was 11.7 (± 11.6). The perineal wound infection rate was 30% and only two patient required mesh removal due to entero-cutaneous perineal fistula and pelvic abscess. Perineal hernia was found in only two patients (4.1%). CRM was negative in 81.6% of the patients. Mean follow-up period was 29.2 (± 16.5) months, and disease recurrence occurred in 9 (18.3%) patients with average number of months for recurrence of 21 (± 7). Overall survival during the follow-up period was 91%.
Conclusion:
Our series shows a favourable short- and medium-term outcome with routine insertion of mesh for perineal wound closure.
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