Prone extralevator abdominoperineal excision of the rectum with porcine collagen perineal reconstruction (Permacol™): high primary perineal wound healing rates.

Abstract

Extralevator abdominoperineal excision of the rectum (elAPER) is arguably the modern surgical approach to low rectal cancer and yet results in large defects that may necessitate plastic surgical reconstruction. This study aims to evaluate the quality of prone elAPER surgery with Permacol™ repair of the perineum. The primary end point studied was the rate of primary perineal wound healing. Data were prospectively collected for consecutive patients having prone elAPER at a single institution to assess surgical morbidity together with pathological and cancer-specific outcomes. Between 2006 and 2012, 48 patients had prone elAPER with median age of 63 (40-86). Thirty-four patients (72.3%) received neoadjuvant treatment. Median length of stay was 9 days (6-66). With a prone approach, three patients had specimen perforation (6.4%) and seven patients had circumferential margin involvement (14.9%). Complete perineal wound healing was achieved in 34 patients (73.9%) at 4 weeks. Four patients (8.3%) were unhealed at 6 months; one patient required a perineal sinus to be laid open, and another patient required plastic surgical reconstruction. No perineal wound herniae have been identified during follow-up. Acceptable oncological outcomes are achieved with the prone extralevator approach. The technique achieves high rates of primary healing, making it an attractive option in centres without access to plastic reconstructive expertise.