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Published in:

01-03-2005

Primary Perineal Wound Closure After Preoperative Radiotherapy and Abdominoperineal Resection has a High Incidence of Wound Failure

Authors: Kelli M. Bullard, M.D., Judith L. Trudel, M.D., Nancy N. Baxter, M.D., Ph.D., David A. Rothenberger, M.D.

Published in: Diseases of the Colon & Rectum | Issue 3/2005

PURPOSE

Neoadjuvant radiation therapy has been used increasingly to downstage rectal cancer and decrease local recurrence. Despite its efficacy, preoperative radiation therapy may inhibit healing and contribute to wound complications. This study was designed to evaluate perineal wound complications after abdominoperineal resection.

METHODS

The clinical records of a consecutive series of patients who underwent abdominoperineal resection for rectal carcinoma between 1988 and 2002 were reviewed. Demographic data, disease stage, and use of preoperative radiation therapy were recorded. Major wound complications included delayed wound healing (>1 month), wound infection requiring drainage/debridement, or reoperation.

RESULTS

A total of 160 patients underwent abdominoperineal resection with primary closure of the perineal wound (mean age, 63 ± 12 years); 117 (73 percent) patients received preoperative radiation therapy; 114 received radiation therapy for rectal cancer (radiation therapy + chemotherapy = 107, radiation therapy alone = 7); 3 received radiation therapy for other pelvic malignancies. Median radiation dose was 5,040 (range, 900–5,400) cGY. Overall wound complication rate was 41 percent. Major wound complication rate was 35 percent. Delayed healing was the most common complication (24 percent), followed by infection (10 percent). Radiation therapy increased the risk of any wound complication (47 vs. 23 percent; P = 0.005), risk of a major wound complication (41 vs. 19 percent; P = 0.021), and risk of infection (14 vs. 0 percent; P = 0.015). Risk of wound complications did not correlate with age, gender, disease stage, smoking, or diabetes.

CONCLUSIONS

Wound complications are frequent after abdominoperineal resection and primary closure of the perineum. Preoperative radiation therapy doubles the rate of total and major perineal wound complications. Alternatives to primary perineal closure should be considered, particularly after radiation therapy.

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Title: Primary Perineal Wound Closure After Preoperative Radiotherapy and Abdominoperineal Resection has a High Incidence of Wound Failure
Authors: Kelli M. Bullard, M.D.
Judith L. Trudel, M.D.
Nancy N. Baxter, M.D., Ph.D.
David A. Rothenberger, M.D.
Publication date: 01-03-2005
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 3/2005
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-004-0827-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Primary Perineal Wound Closure After Preoperative Radiotherapy and Abdominoperineal Resection has a High Incidence of Wound Failure

PURPOSE

METHODS

RESULTS

CONCLUSIONS

Keynote webinar | Spotlight on medication adherence

Springer Medicine

PURPOSE

METHODS

RESULTS

CONCLUSIONS

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