Wound Complications and Perineal Pain After Extralevator Versus Standard Abdominoperineal Excision: A Nationwide Study

TY - JOUR

T1 - Wound Complications and Perineal Pain After Extralevator Versus Standard Abdominoperineal Excision

T2 - A Nationwide Study

AU - Colov, Emilie Palmgren

AU - Klein, Mads

AU - Gögenur, Ismail

PY - 2016/9/1

Y1 - 2016/9/1

N2 - BACKGROUND: Extralevator abdominoperineal excision was introduced as an alternative to conventional abdominoperineal excision for low rectal cancers. The perineal dissection is more extensive with extralevator abdominoperineal excision and leaves a greater defect. OBJECTIVE: The aim of this study was to evaluate, on a national basis, the risk of perineal wound complications, pain, and hernia after conventional and extralevator abdominoperineal excision performed for low rectal cancer. DESIGN: This was a retrospective study collecting data from the Danish Colorectal Cancer Group database and from electronic medical files of patients. SETTINGS: The study was conducted at Danish surgical departments. PATIENTS: A total of 445 patients operated between 2009 and 2012 with extralevator or conventional abdominoperineal excision were included. MAIN OUTCOME MEASURES: The main end points of this study were perineal wound complications and pain lasting for >30 days after the operation. RESULTS: The 2 groups were demographically similar except for a higher ASA score in the conventional group. In the extralevator group, neoadjuvant chemoradiation was more frequent (71% vs 41%; p < 0.001), T stage was higher (more T3 tumors; 52% vs 38%; p = 0.006), and more tumors were fixed (21% vs 12%; p = 0.02). Perineal wound complications and pain were more frequent after extralevator versus conventional excision (44% vs 25%; p < 0.001 and 38% vs 22%; p < 0.001). After multivariate analyses, neoadjuvant chemoradiation, extralevator excision, and operation early in the study period were found to have a significant influence on the risk of long-term wound complications. Neoadjuvant chemoradiation and wound complications were significant risk factors for long-term perineal pain. Results were similar after subgroup analyses on low tumors only. LIMITATIONS: This was a retrospective study. The 2 groups were not completely comparable at baseline. CONCLUSIONS: Neoadjuvant chemoradiation, extralevator compared with conventional excision, and operation early in the study period were significant factors for predicting perineal wound complications. Neoadjuvant chemoradiation and wound complications were predictors of long-term perineal pain.

AB - BACKGROUND: Extralevator abdominoperineal excision was introduced as an alternative to conventional abdominoperineal excision for low rectal cancers. The perineal dissection is more extensive with extralevator abdominoperineal excision and leaves a greater defect. OBJECTIVE: The aim of this study was to evaluate, on a national basis, the risk of perineal wound complications, pain, and hernia after conventional and extralevator abdominoperineal excision performed for low rectal cancer. DESIGN: This was a retrospective study collecting data from the Danish Colorectal Cancer Group database and from electronic medical files of patients. SETTINGS: The study was conducted at Danish surgical departments. PATIENTS: A total of 445 patients operated between 2009 and 2012 with extralevator or conventional abdominoperineal excision were included. MAIN OUTCOME MEASURES: The main end points of this study were perineal wound complications and pain lasting for >30 days after the operation. RESULTS: The 2 groups were demographically similar except for a higher ASA score in the conventional group. In the extralevator group, neoadjuvant chemoradiation was more frequent (71% vs 41%; p < 0.001), T stage was higher (more T3 tumors; 52% vs 38%; p = 0.006), and more tumors were fixed (21% vs 12%; p = 0.02). Perineal wound complications and pain were more frequent after extralevator versus conventional excision (44% vs 25%; p < 0.001 and 38% vs 22%; p < 0.001). After multivariate analyses, neoadjuvant chemoradiation, extralevator excision, and operation early in the study period were found to have a significant influence on the risk of long-term wound complications. Neoadjuvant chemoradiation and wound complications were significant risk factors for long-term perineal pain. Results were similar after subgroup analyses on low tumors only. LIMITATIONS: This was a retrospective study. The 2 groups were not completely comparable at baseline. CONCLUSIONS: Neoadjuvant chemoradiation, extralevator compared with conventional excision, and operation early in the study period were significant factors for predicting perineal wound complications. Neoadjuvant chemoradiation and wound complications were predictors of long-term perineal pain.

KW - Abdomen

KW - Adult

KW - Aged

KW - Chemoradiotherapy, Adjuvant

KW - Denmark

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Incisional Hernia

KW - Male

KW - Middle Aged

KW - Neoadjuvant Therapy

KW - Pain, Postoperative

KW - Perineum

KW - Rectal Neoplasms

KW - Rectum

KW - Retrospective Studies

KW - Risk Factors

KW - Surgical Wound Dehiscence

KW - Surgical Wound Infection

KW - Comparative Study

KW - Journal Article

U2 - 10.1097/DCR.0000000000000639

DO - 10.1097/DCR.0000000000000639

M3 - Journal article

C2 - 27505109

SN - 0012-3706

VL - 59

SP - 813

EP - 821

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

IS - 9

ER -