Postoperative Complications in Patients Undergoing Nonabdominal Wall Flap Reconstruction after Laparoscopic or Robotic Abdominoperineal Resection

Abstract

INTRODUCTION: Abdominoperineal resection (APR) is the treatment of choice for patients with rectal cancer. Typically, reconstruction after APR is done with a rectus abdominus myocutaneous (RAM) flap. Given the increased management with laparoscopic APRs, abdominally based flap reconstruction is inappropriate because of its invasiveness and significant abdominal wall morbidity. Therefore, a nonabdominal wall based free flap alternative, such as an anterior lateral thigh flap, gluteal flap, or gracilis flap, may be a superior approach looking forward. The aim of this study is to evaluate postoperative short- and long-term complication rates in patients undergoing nonabdominal wall flap reconstruction after laparoscopic or robotic APR. METHODS: We conducted a review of the literature to include adults with rectal cancer and looked at short-term complications such as increased healing time, seroma, hematoma, surgical site infection, dehiscence rates, reoperation rates, as well as long term complications such as perineal hernia rates. RESULTS: Our study included 64 articles and 306 flaps. The overall wound complication rate was 15.0%. In the short-term, 23 patients experienced hematomas, 16 patients experienced surgical site infection, 3 patients dehisced, and 4 required reoperations. The ALT flap offered the lowest rate of complications at 9.3%. CONCLUSION: In conclusion, the wound complication rate of 15.2% was comparable with literature findings of 14.3% in patients with RAM flap reconstruction. Nonabdominal wall-based flap reconstruction is effective after APR. Owing to its low complication rate, the ALT flap may serve as a superior treatment option for laparoscopic or robotic APR in patients with rectal cancer.