Skip to main content

Advertisement

Log in

Prevention of Severe Pelvic Abscess Formation Following Extended Radical Surgery for Locally Recurrent Rectal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

For treatment of locally recurrent rectal cancer (LRRC), extended radical surgery is sometimes required to obtain a negative margin. Such surgery is often associated with severe postoperative pelvic abscess (PA) formation. The aim of this study was to determine the effects of reconstructive surgery using a large rectus abdominis myocutaneous (RAM) flap and anal preservation surgery on the incidence of severe PA.

Method

Between February 1998 and June 2008, 44 patients underwent extended surgery for LRRC. Patients were divided into the pre-2004 group (n = 15) and the post-2004 group (n = 29). To reduce the risk of infections, we modified the surgical approach after 2004 to include a larger volume of RAM flap (modified RAM flap) and implemented anal preservation surgery.

Results

The overall incidence of severe PA was significantly lower in the post-2004 group [6 of 29 (21%)] than the pre-2004 group [9 of 15 (60%), P = 0.017]. The incidence of severe PA was lower in the anal preservation group [1 of 12 (8.3%)] compared with those who did not undergo such surgery [14 of 32 (44%), P = 0.035]. Modified RAM flap reduced the incidence of severe PA, albeit insignificantly (pre-2004 group: 57%, post-2004 group: 23%). All three patients who underwent anal preservation and modified RAM flap reconstruction did not develop severe PA. Multiple logistic analysis identified no anal preservation (Odds ratio [OR] = 10.6) and performing of sacrectomy (OR = 20.0) as risk factors for severe PA.

Conclusion

Anal preservation surgery is an effective measure against the development of severe PA after radical resection of LRRC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients Br J Surg. 1985;72:34–7.

    Article  PubMed  CAS  Google Scholar 

  2. Sagar PM, Pemberton JH. Surgical management of locally recurrent rectal cancer Br J Surg. 1996;83:293–304.

    Article  PubMed  CAS  Google Scholar 

  3. Bozzetti F, Bertario L, Rossetti C, Gennari L, Andreola S, Baratti D, et al. Surgical treatment of locally recurrent rectal carcinoma Dis Colon Rectum. 1997;40:1421–4.

    Article  PubMed  CAS  Google Scholar 

  4. Wanebo HJ, Antoniuk P, Koness RJ, Levy A, Vezeridis M, Cohen SI, et al. Pelvic resection of recurrent rectal cancer: technical considerations and outcomes Dis Colon Rectum. 1999;42:1438–48.

    Article  PubMed  CAS  Google Scholar 

  5. Maetani S, Nishikawa T, Iijima Y, Tobe T, Kotoura Y, Shikata J, et al. Extensive en bloc resection of regionally recurrent carcinoma of the rectum Cancer. 1992;69:2876–83.

    Article  PubMed  CAS  Google Scholar 

  6. Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis Dis Colon Rectum. 2004;47:2047–54.

    Article  PubMed  Google Scholar 

  7. Takagi H, Morimoto T, Hara S, Suzuki R, Horio S. Seven cases of pelvic exenteration combined with sacral resection for locally recurrent rectal cancer J Surg Oncol. 1986;32:184–8.

    Article  PubMed  CAS  Google Scholar 

  8. Temple WJ, Ketcham AS. Sacral resection for control of pelvic tumors Am J Surg. 1992;163:370–4.

    Article  PubMed  CAS  Google Scholar 

  9. Jimenez RE, Shoup M, Cohen AM, Paty PB, Guillem J, Wong WD. Contemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer Dis Colon Rectum. 2003;46:1619–25.

    Article  PubMed  Google Scholar 

  10. Radice E, Nelson H, Mercill S, Farouk R, Petty P, Gunderson L. Primary myocutaneous flap closure following resection of locally advanced pelvic malignancies Br J Surg. 1999;86:349–54.

    Article  PubMed  CAS  Google Scholar 

  11. Smith HO, Genesen MC, Runowicz CD, Goldberg GL. The rectus abdominis myocutaneous flap: modifications, complications, and sexual function Cancer. 1998;83:510–20.

    Article  PubMed  CAS  Google Scholar 

  12. Chessin DB, Hartley J, Cohen AM, Mazumdar M, Cordeiro P, Disa J, et al. Rectus flap reconstruction decreases perineal wound complications after pelvic chemoradiation and surgery: a cohort study Ann Surg Oncol. 2005;12:104–10.

    Article  PubMed  Google Scholar 

  13. Bell SW, Dehni N, Chaouat M, Lifante JC, Parc R, Tiret E. Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection Br J Surg. 2005;92:482–6.

    Article  PubMed  CAS  Google Scholar 

  14. Buchel EW, Finical S, Johnson C. Pelvic reconstruction using vertical rectus abdominis musculocutaneous flaps Ann Plast Surg. 2004;52:22–6.

    Article  PubMed  Google Scholar 

  15. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee Infect Control Hosp Epidemiol. 1999;20:250–78; quiz 279–80.

    Article  PubMed  CAS  Google Scholar 

  16. Sorensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial Ann Surg. 2003;23:1–5.

    Article  Google Scholar 

  17. Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance Ann Surg. 2006;244:758–63.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Masataka Ikeda MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uemura, M., Ikeda, M., Sekimoto, M. et al. Prevention of Severe Pelvic Abscess Formation Following Extended Radical Surgery for Locally Recurrent Rectal Cancer. Ann Surg Oncol 16, 2204–2210 (2009). https://doi.org/10.1245/s10434-009-0505-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-009-0505-6

Keywords

Navigation