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Preoperative Radiotherapy as a Major Risk Factor for Pelvic Abscess after Abdominoperineal Resection and Total Pelvic
Tomoaki Kaneko1, Shuichiro Matoba1, Mitsunori Ushigome1
1Department of Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, Tokyo, Japan.
Journal of the Anus, Rectum and Colon
|July 31, 2026
Summary
Preoperative radiotherapy increases the risk of pelvic abscess after abdominoperineal resection (APR) and total pelvic exenteration (TPE). This finding helps identify high-risk patients for targeted preventive strategies.
Area of Science:
- Surgical Oncology
- Colorectal Surgery
- Postoperative Complications
Background:
- Pelvic abscess and perineal wound infection are significant postoperative complications following abdominoperineal resection (APR) and total pelvic exenteration (TPE).
- Distinct underlying mechanisms necessitate separate evaluation of these complications.
- Identifying specific risk factors for pelvic abscess is crucial for improving patient outcomes.
Purpose of the Study:
- To identify independent risk factors specifically associated with pelvic abscess formation after APR and TPE.
- To differentiate risk factors for pelvic abscess from those of perineal wound infection.
Main Methods:
- Retrospective analysis of 215 patients undergoing APR or TPE between December 2004 and August 2025.
- Comparison of patient characteristics and surgical variables between pelvic abscess and non-abscess groups using univariate and multivariate analyses.
Main Results:
- The overall incidence of pelvic abscess was 18.1% (39/215).
- Preoperative radiotherapy (28.2% vs. 8.5%, p = 0.002) and greater blood loss (894.0 vs. 390.0 mL, p = 0.015) were significantly associated with higher abscess rates in univariate analysis.
- Multivariate analysis confirmed preoperative radiotherapy as an independent predictor of pelvic abscess (p = 0.002).
Conclusions:
- Preoperative radiotherapy is a significant independent risk factor for pelvic abscess after APR and TPE.
- Further research should focus on refining preventive strategies and developing targeted approaches for patients receiving preoperative radiotherapy.
