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Inadvertent perforation of the rectum during abdominoperineal resection
G A Porter1, G E O'Keefe, W W Yakimets
1Department of Surgery, University of Alberta Hospital, Edmonton, Canada.
Background:
Intraoperative inadvertent perforation of the rectum is a potentially avoidable complication of abdominoperineal resection (APR). Although widely thought to be detrimental, the impact of inadvertent perforation on outcome has not been conclusively determined, especially after controlling for potential confounding variables. The objective of this study was to determine if inadvertent perforation of the rectum during APR for rectal cancer is an independent risk factor for the adverse outcomes of local recurrence and/or death.
Methods:
This retrospective cohort study included all patients who underwent APR for primary adenocarcinoma of the rectum at a single teaching hospital from 1980 to 1990. Data were obtained regarding patient demographics, presence of inadvertent perforation, histopathological characteristics, adjuvant therapy, local recurrence, and survival.
Results:
Of 178 patients included in the study, 42 (24%) had inadvertent perforation. By univariate analysis, local recurrence was significantly higher in the perforated group than the nonperforated group (54% vs 17%; P < 0.001). Similarly, 5-year survival was significantly decreased with inadvertent perforation (29% vs 59%; P = 0.003). Multivariate analysis controlling for stage, grade, age, sex, and adjuvant therapy showed inadvertent perforation to be an independent risk factor for both increased local recurrence and decreased 5-year survival (Hazard Ratio for each model).
Conclusions:
Inadvertent perforation of the rectum during APR is associated with increased local recurrence and decreased 5-year survival. The detrimental implications of inadvertent perforation during APR mandates meticulous avoidance.
Insights
Intraoperative rectal perforation during abdominoperineal resection (APR) significantly increases local recurrence and decreases 5-year survival. Meticulous surgical technique is crucial to avoid this complication in rectal cancer patients.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Rectal Cancer Treatment
Background:
- Intraoperative rectal perforation is a known complication of abdominoperineal resection (APR).
- The impact of inadvertent perforation on patient outcomes after APR has not been definitively established.
- This study investigates rectal perforation as an independent risk factor for adverse outcomes in rectal cancer surgery.
Purpose of the Study:
- To determine if inadvertent rectal perforation during APR for rectal cancer is an independent risk factor for local recurrence.
- To assess the association between inadvertent rectal perforation during APR and 5-year survival rates.
Main Methods:
- Retrospective cohort study of 178 patients undergoing APR for rectal adenocarcinoma (1980-1990).
- Data collected on patient demographics, perforation status, histopathology, adjuvant therapy, local recurrence, and survival.
- Univariate and multivariate analyses were performed to control for confounding variables.
Main Results:
- 24% of patients experienced inadvertent rectal perforation during APR.
- Local recurrence was significantly higher in the perforated group (54% vs. 17%; P < 0.001).
- Five-year survival was significantly lower in the perforated group (29% vs. 59%; P = 0.003).
- Multivariate analysis confirmed perforation as an independent risk factor for increased recurrence and decreased survival.
Conclusions:
- Inadvertent rectal perforation during APR is significantly associated with adverse oncological outcomes.
- The findings underscore the importance of meticulous surgical technique to prevent rectal perforation during APR.
- Avoiding rectal perforation is critical for improving survival and reducing recurrence in rectal cancer patients undergoing APR.