Abdominoperineal Resection For Rectal Carcinoma Research Articles

A new surgical approach of direct perineal wound full-thick closure for perineal wound of abdominoperineal resection for rectal carcinoma: A prospective cohort trial.

Perineal wound complications after APR have high morbidity in the colorectal surgical department. Although some approaches have been figured out to solve this clinical focus, the outcomes are still not satisfied. Herein, this prospective comparative clinical trial has been designed to evaluate a new surgical procedure of direct perineal wound full‐thick closure (DPWC), compared with conventional perineal wound closure (CPWC), with hopes of making wound healing with less complications. In addition, an evaluation of an incision negative wound pressure therapy, as another focus in this field, was also analysed in the DPWC group. A total of 44 participants in our department were recruited from March 2018 to March 2020, divided into two groups randomly, CPWC group and DPWC group. The patients' characteristics, such as age, gender, BMI, smoking, alcohol consumption, comorbidities, CEA level, and high‐risk of invasion, were recorded without statistical significance between the CPWC group and DPWC group. After the same standard abdominal phase, these two groups were performed in different perineal phases. And then, operative and postoperative outcomes were analysed with different statistical methods. Data on wound healing time and length of stay in the DPWC group were shorter than those in the CPWC group (P < .05). Furthermore, cases of wound infection within 30 days in the DPWC group were also less than that in the CPWC group (P < .05). However, no difference was found between the incisional negative pressure wound therapy assisted group (NPA group) and non‐ incisional negative pressure wound therapy assisted group (non‐NPA group). During this study, hypoalbuminemia, as an independent high‐risk factor, impacted perineal wound healing. (P = .0271) In conclusion, DPWC is a new surgical approach, which can lead to a better outcome than DPWC, and it can be another surgical procedure for clinicians. In addition, hypoalbuminemia should be interfered for avoiding perineal wound complications.

Outcomes of Laparoscopic Abdominoperineal Resection in Low Rectal Cancer Using Different Pelvic Drainages

The aim of this study was to establish the feasibility and efficiency of different pelvic drainage routes after laparoscopic abdominoperineal resection (LAPR) for rectal cancer by assessing short-term outcomes. Clinicopathological data of 76 patients undergoing LAPR for very low rectal cancer were reviewed retrospectively between June 2005 and June 2014. Outcomes were evaluated considering short- term results. Of 76 relevant patients at our institution in the period of study, trans-perineal drainage of the pelvic cavity was performed in 17 cases. Compared with the trans-perineal group, the length of hospital stay was shorter in the trans-abdominal group, while the duration of drainage and the infection rates of the perineal wounds between two groups showed no significant differences. The outcomes of this study suggest that trans-abdominal drainage of pelvic cavity is a reliable and feasible procedure, the duration of drainage, infection rates and the healing rates of the perineal wounds being acceptable. Trans-abdominal drainage has a more satisfactory effect after laparoscopic abdominoperineal resection for rectal carcinoma.

Wound Dehiscence After Abdominoperineal Resection for Low Rectal Cancer Is Associated With Decreased Survival

Abdominoperineal resection for low rectal adenocarcinoma is a common procedure with high morbidity, including perineal wound complications. The purpose of this study was to determine risk factors for perineal wound dehiscence and to investigate the effect of wound dehiscence on survival. This was a retrospective medical chart review. The study was conducted in a tertiary care university medical center. Patients included in the study were those with low rectal adenocarcinoma who underwent abdominoperineal resection between January 2001 and June 2012. We assessed the incidence of perineal wound dehiscence, as well as survival, after surgery. A total of 249 patients underwent abdominoperineal resection for rectal carcinoma. The mean age was 62.6 years (range, 23.0-98.0 years), 159 (63.8%) were male, and the mean BMI was 27.9 (range, 16.7-58.5). There were 153 patients (61.1%) who survived for 5 years after surgery. Sixty-nine patients (27.7%) developed wound dehiscence. Multivariable analysis revealed the following associations with dehiscence: BMI (OR, 1.09; 95% CI, 1.03-1.15; p = 0.002), IBD (OR, 6.6; 95% CI, 1.4-32.5; p = 0.02), history of other malignant neoplasm (OR, 3.1; 95% CI, 1.5-6.6), and abdominoperineal resection for cancer recurrence (OR, 2.8; 95% CI, 1.2-6.3; p = 0.01). In the survival analysis, wound dehiscence was associated with decreased survival (mean survival time for dehiscence vs no dehiscence, 66.6 months vs 76.6 months; p = 0.01). This relationship persisted in the multivariable analysis (HR, 1.7; 95% CI, 1.1-2.8; p = 0.02). This was a retrospective, observational study from a single center. The adjusted risk of death was 1.7 times higher in patients who experienced dehiscence than in those who did not. Attention to perineal wound closure with consideration of flap creation should at least be given to patients with a history of malignant neoplasm, those with IBD, those with rectal cancer recurrence, and women undergoing posterior vaginectomy. Preoperative weight loss should also reduce dehiscence risk.

Three major problems and solutions in laparoscopic abdominoperineal resection for rectal carcinoma

To investigate the three major problems and solutions in laparoscopic abdominoperineal resection(APR) for rectal carcinoma. A retrospective study of 60 low rectal carcinoma cases undergoing selective laparoscopic APR from September 2010 to May 2013 in our hospital was undertaken. A laparoscopic sigmoid stoma was performed through the extraperitoneal route at the left lower abdomen puncture point after lymphadenectomy and tumor excision during operation. Using the unique intracorporeal suture technique of transanal endoscopic microsurgery(TEM), the pelvic peritoneum was closed by continuous suture with TEM needle-forceps and absorbable suture. Those patients with the successful pelvic peritoneum closure received continuous irrigation of presacral space from the third postoperative day to prevent perineal incision infection. Only one patient (1.7%) was converted to laparotomy. Fifty-nine patients underwent laparoscopic APR and laparoscopic sigmoid stoma was successfully performed through the extraperitoneal route without abdominal incision, and the incidence of stoma complication was only 3.4%. Out of 59 patients undergoing laparoscopic APR, the pelvic peritoneum of 56 patients(94.9%) was closed successfully. The median time of closing the pelvic peritoneum was 15 min. Fifty-seven patients with pelvic peritoneum successfully closed by laparotomy or laparoscopic approach received continuous irrigation of presacral space and the median time of presacral drainage tube placement was 7.8 days. No patient developed postoperative intestinal obstruction. The rate of perineal wound healing in grade A, B and C was 87.7%, 8.8% and 3.5%, respectively. In the 3 patients whose pelvic peritoneum failed to be closed with simple drainage of presacral space, one developed postoperative intestinal obstruction and one had a grade C perineal wound healing. Laparoscopic sigmoid stoma through the extraperitoneal route during laparoscopic APR for rectal carcinoma is feasible and safe. It is convenient and effective to close pelvic peritoneum by using TEM intracorporeal suture technique. It is worth discussing the role of continuous irrigation of presacral space postoperatively to prevent perineal incision infection.

Basaloid large cell lung carcinoma presenting as cutaneous metastasis at the colostomy site after abdominoperineal resection for rectal carcinoma

The occurrence of a tumor at the colostomy site after abdominoperineal resection for rectal carcinoma is rare and it may be related to a previously resected carcinoma or another primary tumor. We report a 61-year-old man who developed an ulcerated skin nodule at her colostomy site 6 years after resection of a rectal adenocarcinoma. Histopathologically, the skin nodule was composed of atypical large and pleomorphic cells with high mitotic rate and they were arranged in nests and within lymphatic channels in the dermis. The neoplastic cells were immunoreactive for cytokeratin (CK) AE1/3, CK7, CK34ßE12, epithelial membrane antigen and vimentin while detection of human papillomavirus and Epstein-Barr virus DNA was negative. A diagnosis of basaloid large cell carcinoma of pulmonary origin was suggested and it was confirmed by computed tomography-guided fine needle aspiration of a right subpleural mass. A metastatic tumor at the colostomy site is an exceptional finding and may be the first manifestation of lung cancer, especially if it consist of pleomorphic large cells with high mitotic rate and basaloid immunophenotype.

Surgery for lung adenocarcinoma with smokers’ polycythemia: a case report

BackgroundSmoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers’ polycythemia has never been reported. We herein report a patient with lung cancer and smokers’ polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period.Case presentationA 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA). When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists’ diagnosis was secondary polycythemia due to heavy smoking (smokers’ polycythemia) because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at <50% postoperatively, and the patient was uneventfully discharged on postoperative day 7. The predictive hematocrit and measured hematocrit were very closely approximated in this case.ConclusionWe experienced a patient with smokers’ polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.

Successful pregnancy after abdominoperineal resection for rectal carcinoma in a young patient

Rectal carcinoma is rare in young patients under twenty years of age, consisting of only 1% of colorectal carcinomas at all ages [1,2]. Abdominoperineal resection is known to cause sexual dysfunction and reduced quality of life. We report a case of successful pregnancy and more than ten years of disease free survival following abdominoperineal resection for rectal carcinoma in a teenage female. The Sri Lanka Journal of Surgery 2012; 30(2):24 http://dx.doi.org/10.4038/sljs.v30i2.5179

Successful management of osteoradionecrotic precoccygeal defect with the free latissimus dorsi muscle flap: Case report and literature review

Perineal wound complications following abdominoperineal resection (APR) are still frequent and most troublesome complications. We report the case of a 79-year-old male found to have the huge precoccygeal defect with infection after APR for rectal carcinoma. Before surgery, the patient received a complete course of chemoradiation therapy to treat for downgrade staging of the rectal malignancy. Extensive debridement of the perianal wound was performed for three times, followed by perianal reconstruction and packing and augmentation of the precoccygeal dead space with free latissimus dorsi (LD) muscle flap. Although persisted wound infection was still observed after reconstruction, the patient still led a good result after one time of further debridement and split-thickness skin graft. We selected free LD muscle flap to fill and seal off the large pelvic dead space without the needs to change the jackknife position of the patient after debridement. To the best of our knowledge, this is the first case reported in the literature with the radiation-associated perianal wound infection after APR reconstructed successfully by free LD muscle flap.

The current abdominoperineal resection: Oncological problems and surgical modifications for low rectal cancer

Abdominoperineal resection is the one of the oldest surgical procedures for rectal cancer. Outcome after abdominoperineal resection for rectal carcinoma is not as good as anterior resection as the risk of local recurrence is higher and survival is poorer. During abdominoperineal resection, the rate of rectal perforation is high and the circumferential margin is often involved. Recently the concept of cylindrical abdominoperineal resection has been reintroduced. It allows a large excision and the initial results are encouraging. The purpose of this article was to analyse the oncological results of abdominoperineal resection and to develop the potential technical modifications of the procedure.

Wound Complications in Rectal Cancer Patients Undergoing Primary Closure of the Perineal Wound After Abdominoperineal Resection

Perineal wound complications have a significant impact on postoperative morbidity after excision of the rectum and anus. The aim of this study is to evaluate factors affecting perineal wound complications after primary closure of the wound following abdominoperineal resection. Data were reviewed from all patients who underwent abdominoperineal resection for rectal carcinoma between 1982 and 2007. Data pertaining to demographics, tumor characteristics, and use of preoperative neoadjuvant therapy were retrieved. Complications studied included delayed wound healing, wound infection, dehiscence, abscess or sinus, reoperation, and perineal hernias. Patients who developed perineal wound complications (Group A) were compared with the remaining patients (Group B) to evaluate factors associated with the development of perineal wound complications. Six hundred ninety-six patients (59% male) met the inclusion criteria. The mean age was 63 years (standard deviation, 13), and the mean body mass index was 28.9 kg/m2 (standard deviation, 7.8). Two hundred seventy-three patients (39.2%) received neoadjuvant chemoradiation. The overall rate of wound complications was 16.2%, and reoperation was required in 5.2% of patients. Group A and Group B patients were similar with respect to age (P = 0.1), gender (P = 0.7), grade (P = 0.4), and stage of disease (P = 0.5). A greater proportion of Group A patients had associated comorbidity (P = 0.001), obesity (0.04), neoadjuvant chemoradiation (0.02), and intraoperative bleeding (0.04). In multivariate analysis, comorbidity was the only independent factor associated with the development of perineal complications (odds ratio, 1.8 (1.09-2.96)). Most patients have perineal wound healing without complications after abdominoperineal resection. In multivariate analysis, comorbidity was the only significant factor that predicted perineal wound complications.

Metachronous multiple carcinomas arising at a colostomy site 18 years after abdominoperineal resection

Dear Editor: Metachronous multiple carcinomas at the site of stoma is rare condition after surgery. A median of 264 months interval from the initial operation was documented in 35 cases reported. In 1958, the following criteria for multiple carcinomas of the colon were defined by Mortel: (1) malignancy of a lesion, as indicated by histopathological examination; (2) synchronous carcinomas, with normal mucosa existing between the tumors; and (3) for metachronous carcinomas, a tumor, except for a tumor occurring at an anastomosis, which is not suspected of being an invasion, metastasis, or recurrence of another tumor. They reported that multiple carcinomas accounted for 4.3% of all colorectal carcinomas and for 12.9% of colorectal carcinomas and polypoid carcinoma of the colon. In 1996, the Cancer Registry of the Japanese Society for Cancer of the Colon and Rectum reported that multiple carcinomas occurred in 9.7% of patients (synchronous, 4.3%; metachronous, 5.4%). To our knowledge, 45 cases of stoma carcinomas that include both synchronous and metachronous carcinomas have been reported in Japan. Among them, 35 cases (25 men, median=68 years, range=38–88 years), including the present case, fulfilled the above criteria for metachronous multiple carcinomas arising at the site of colostomy. Thirty of the 35 cases underwent abdominoperineal resection for rectal carcinoma. The median time of development from initial operation to second tumor was 264 months (range= 19–504 months). In 24 of the 35 cases (68.6%), the second tumor was discovered more than 10 years after the initial surgery. As for the histology, adenocarcinoma was confirmed in 30 of the 35 cases (85.7%) and mucinous adenocarcinoma in three cases. These proportions were equivalent to common advanced cases in our series. In the present case, the patient did not recognize the possibility of carcinoma occurrence or growth more than 10 years. The fact suggests that most of the patients might not recognize the occurrence of a carcinoma in a stoma. Occurrence of carcinoma in the stoma site is a rare condition, but carcinoma can occur in a stoma. The refined observation of a stoma might be suggested for the ostomate for long period after stoma creation. Int J Colorectal Dis (2009) 24:1481 DOI 10.1007/s00384-009-0752-9

Desmoid Tumor Arising at the Colostomy Site After Abdominoperineal Resection for Rectal Carcinoma: Report of a Case

A 69-year-old male who developed a desmoid tumor at the site of his end colostomy after abdominoperineal resection for rectal carcinoma is reported. The tumor was resected with wide margins. Histopathology revealed desmoid tumor of the anterior abdominal wall with no malignant features. The patient had an uneventful postoperative course. To our knowledge, this is the first case of solitary desmoid tumor of anterior abdominal wall at the colostomy site reported in the literature.

Survival after peranal and abdominoperineal resection for rectal carcinoma.

The outcome of a consecutive series of 47 patients with rectal cancer treated by endoscopic transanal resection or peranal local excision was contrasted with that of 42 patients undergoing abdominoperineal resection. Surgery was considered curative for 35 and nine patients treated by abdominoperineal and peranal resection respectively (P < 0.001). Patients undergoing peranal excision were older than those treated by abdominoperineal resection (median 77 versus 69 years, P < 0.01). The 5-year survival rate of patients undergoing peranal resection was 24 per cent compared with 33 per cent for those treated by the abdominoperineal procedure (P < 0.005). When surgery was palliative the survival rate after both procedures was the same. Survival after peranal excision was significantly poorer than that after abdominoperineal resection but this may be acceptable when the stage of disease and age of the patients are taken into account.

Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival.

Abstract Fifty consecutive specimens, obtained in the course of potentially curative abdominoperineal resection for rectal carcinoma situated 5–10 cm from the anal verge, were examined for the presence of microscopic distal intramural spread. Thirty-eight patients (76 per cent) were found to have no distal intramural spread. Seven patients (14 per cent) had spread for 1 cm or less and only 5 patients (10 per cent) had spread of more than 1 cm. Each of these 5 patients had a poorly differentiated Dukes' C carcinoma and each was dead or dying from distant metastases within 3 years of the operation. The results of anterior resection for carcinoma of the rectum were reviewed a minimum of 5 years after operation, to find out whether patients with a wide distal margin of resection had fared better than patients with a small margin. Seventy-nine patients had undergone a potentially curative resection, 48 with a distal margin of less than 5 cm (mean 2·8 cm; group 1) and 31 with a distal margin greater than 5 cm (mean 6·5 cm; group 2). The two groups were well matched for age, sex, degree of differentiation of the tumours and distance of the lesion from the anal verge, but 54 per cent of patients in group 1 had Dukes' grade C tumour whereas only 23 per cent of the patients in group 2 had Dukes' C tumours. Despite the higher proportion of unfavourable tumours in group 1, the outcome, in terms both of survival and of recurrence, was as good in the patients with the small distal margin as in the patients with the wide distal margin of clearance. The rigid, routine application of the 5 centimetre rule' of distal excision may cause patients with low rectal cancer to lose their anal sphincter unnecessarily.

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

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. 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. 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. 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.

Anorectal reconstruction after abdominoperineal resection. Experience with double-wrap graciloplasty supported by low-frequency electrostimulation.

The aims of the study contained herein were to analyze the efficacy and safety of a chronically electrostimulated double-wrap graciloplasty for restoration of continence after a curative abdominoperineal resection for rectal carcinoma and to evaluate late results of a stimulation protocol that was begun early. During the last six years, 31 consecutive patients underwent this procedure: in 24 patients, electrostimulated double-wrap graciloplasty was performed simultaneously with abdominoperineal resection for lower rectal cancer, 7 strictly selected patients underwent conversion to an abdominal stoma following previous abdominoperineal resection (mean length of time from stoma creation, 71.4 months) Anorectal reconstruction was performed following a surgical scheme already standarized since 1985 in 102 patients: after abdominoperineal resection, the distal colon was pulled through to the perineum and surrounded by both gracilis muscles following an "alfa and new-sling" configuration; using platinumiridium electrodes, both muscles were then connected to pulse generator, which was implanted subcutaneously in the abdomen. All surgical steps were performed during the same surgical session to allow early postoperative stimulation of the transposed muscles. A contemporary covering stoma was abandoned as a standard procedure; the distal colon was left closed for a few postoperative days, then it was resected and sutured to the perineum under local anesthesia. Eighteen patients underwent preoperative or postoperative radiotherapy or both, without any significant adverse outcome. To increase gracilis resistance to prolonged "tonic" contraction, patients underwent a chronic, low-frequency stimulation protocol. In the last 11 patients, a new "over-the-nerve and intramuscular" implant was adopted to optimize fiber recruitment and to reduce electrostimulation thresholds. At regular intervals, all patients were evaluated using continence scores and questionnaires, electromanometry, endoluminal ultrasound study, and defecography. Twenty-six of 31 patients were evaluated for continence, with a mean length of follow-up of 37.8 (range, 4-68) months; 3 patients died because of cancer recurrence, 1 underwent conversion to an abdominal stoma, and 1 is waiting for stoma closure. Continence to liquid and solid stools was achieved in 22 patients (85 percent), and electromanometry findings confirmed a good muscular contraction postoperatively and during follow-up intervals. No postoperative mortality (40 days) was observed; the postoperative complication rate was high 22-percent), but early treatment (drainage and temporary diversion in 7 patients) led to favorable outcomes (4 resolutions, 3 partial muscular impairments). Four stimulators had to be temporarily explanted because of late complications, and two stimulators had to be replaced because of battery exhaustion after three years of use with high stimulation parameters. A significant difference was observed comparing full-contracting threshold after intramuscular (14 patients) and the new over-the-nerve and intramuscular implant technique. The study contained herein confirms the efficacy of the surgical scheme we have adopted since 1985 to reconstruct sphincteric apparatus after abdominoperineal resection of the rectum. The "one-step" timing of surgical and electrostimulation-related procedures and the early start of stimulation did not show a significant increase in the complication rate and did not produce noticeable muscular or nerve damage. Adoption of chronic electrostimulation protocols using implantable devices increased the rate of fully continent patients; nevertheless, the overall cost for devices and medical staff duties was high, and a small increase of late morbidity was observed. Finally, the preliminary experience with our new technique of electrode implants encourages further application.

CT of the urinary tract after abdominoperineal resection for rectal carcinoma.

Computed tomography (CT) after abdominoperineal (AP) resection for rectal carcinoma is a routine procedure for the detection of recurrent tumor and distal metastases. We reviewed sequential CT scans after AP resection in 52 patients in order to see whether the urinary tract as a neighboring organ is involved in recurrent malignancy. Bladder displacement in itself was not associated with hydronephrosis. Such hydronephrosis developed, however, in 14 patients--13 with a presacral mass, and one with retroperitoneal lymphadenopathy. In 23 of the 52 patients a presacral mass appeared, either fibrosis, infection, or recurrence. Severe hydronephrosis was found only with malignancy. We suggest that marked hydronephrosis associated with a presacral mass after AP resection is an indirect sign of malignancy.

Urogenital dysfunction after abdominoperineal resection for carcinoma of the rectum

The long-term urogenital dysfunctions in 46 of 104 surviving patients submitted to abdominoperineal resection for rectal carcinoma between 1972 and 1986 were collected and assessed. Urinary retention was present in 41 percent of the men and 35 percent of women, while incontinence was present in 10 percent of men and 29 percent of women. Impotence was reported by 59 percent of the males, all sexually active before surgery. Dyspareunia was present in 50 percent of the women in the study. The possibility of treating prostatic hypertrophy concurrently with abdominoperineal resection in selected cases to avoid urinary retention is discussed. The limited number of responders to the survey may interfere with the global statistical significance.

Delayed bladder dysfunction after abdominoperineal resection: An indicator of local recurrence

It is generally not appreciated that the delayed onset of voiding dysfunction after abdominoperineal resection for rectal carcinoma may be the first sign of local pelvic recurrence. We herein present a series of 5 patients who were referred for urodynamic evaluation of voiding dysfunction beginning nine to twenty-four months after the original operative procedure. Urodynamic evaluation revealed low bladder wall compliance in 4 patients, and detrusor hyperref lexia in 1 patient. Computerized tomography scans confirmed the local tumor recurrence in all cases. The delayed onset of voiding complaints after abdominoperineal resection should prompt a high index of suspicion that a local tumor recurrence may be present.

The morbidity of perineal wounds following abdominoperineal resection for rectal carcinoma.

The clinical charts of 44 patients who underwent an abdominoperineal resection for adenocarcinoma of the rectum at Roswell Park Memorial Institute were retrospectively reviewed. The morbidity of an open perineal wound versus the closed perineal wound were evaluated. All of the patients received a Nichol's bowel preparation and following the abdominal portion of the dissection reperitonealization of the pelvic floor was performed. The overall morbidity for the open perineal wounds was 21% compared to a morbidity of 63% for the perineal wounds that were closed primarily. The mean length of hospitalization from the time of abdominoperineal resection was 21 days for the open perineal group and 22 days for the closed perineal group. The inclusion of wound sinus tracts in our morbidity assessment may explain the higher complication rate of the closed wound group than previously reported in the literature. This retrospective review emphasizes that the morbidity of the open perineal wound following abdominoperineal resection has been overemphasized. One is trading a potentially increased incidence of septic wound complications in the closed perineum for a protracted wound closure in the open perineum.