Prone cylindrical abdominoperineal resection with subsequent rectus abdominis myocutaneous flap reconstruction performed by a colorectal surgeon

Abstract

Prone cylindrical abdominoperineal resection (APR) leads to reduced circumferential resection margin (CRM) involvement but is associated with a large perineal deficit. A rectus abdominis myocutaneous (RAM) flap can reduce the morbidity associated with the perineal wound. This is often performed in coordination with a plastic surgeon. We reviewed the outcome of prone APR carried out by a single colorectal surgeon using RAM flap without the involvement of plastic surgeons in a district general hospital. Data were reviewed retrospectively for consecutive patients who have undergone prone cylindrical APR and RAM flap reconstruction between 2008 and 2011. Additional data were reviewed for all patients who have undergone supine APR between 2004 and 2008 for comparison. Twelve patients (seven females, five males) of median age of 69years (range 50-84years) underwent prone APR and RAM flap reconstruction. The CRM was negative in all cases. One patient had complete flap necrosis and subsequent flap removal, and three (25%) patients experienced delayed flap healing. One patient died from bronchopneumonia following a cerebrovascular accident at day 14. In the preceding 4years, nine patients (three females, six males) of median age of 70years (range 32-83years) underwent supine APR alone. The CRM was negative in all cases. Three patients suffered breakdown of the perineal wound requiring prolonged packing, and one developed a methicillin-resistant Staphylococcus aureus wound infection. Prone APR and RAM flap reconstruction can be performed by colorectal surgeons in a district general setting with good outcomes, without the need for a plastic surgeon, thus increasing the feasibility of this treatment modality.