Mohr Z, Palmer B, Zender F-J, Willis S, Lehnhardt M, Daigeler A, Kremer T, Hirche C
Allgemein-, Viszeral-, Thorax- und Unfallchirurgie, Klinikum der Stadt Ludwigshafen am Rhein, Deutschland.
Klinik für Plastische und Handchirurgie, Universität Heidelberg, Heidelberg, Deutschland.
Zentralbl Chir. 2014 Dec;139 Suppl 2:e55-62. doi: 10.1055/s-0032-1315236. Epub 2013 Mar 4.
Multimodal treatment options for ultra-low neoplasms of the rectum or anal cancer include chemotherapy, radical abdominoperineal resection and/or radiation. Primary wound closure increases the risk of perineal wound complications that require secondary revision. Perineal wound complications may trigger delay of adjacent tumor therapy and thus have an impact on rate of local recurrence and long-term survival for rectal cancer. Simultaneous primary reconstruction of the perineal defect has been shown to reduce the incidence of perineal wound complications as well as hospital stay which enables timely adjacent therapy and may improve prognosis.
This study was designed to retrospectively evaluate wound complications after abdominoperineal resection by comparing a group with and one without primary perineal reconstruction. Between 2005 and 2011, patients were analysed and divided into cohorts 1 and 2. Cohort 1 included n = 33 patients without primary perineal reconstruction. Cohort 2 included n = 4 patients with primary perineal reconstruction. Risk factors were identified for increased wound complications and delay of adjacent therapy.
Subgroup analysis revealed that 18 out of 33 patients of cohort 1 had wound complications. In five cases, prolonged wound healing resulted in a delay of adjacent therapies. Four patients suffered from progression of tumour, 2 out of these 4 patients had a history of delayed adjacent therapy. The main risk factor for prolonged wound healing due to postoperative complications was a history of neoadjuvant treatment resulting in a rate of 64.7 %. Cohort 2 undergoing primary reconstruction presented without wound complications or delay in adjuvant therapy.
A primary perineal reconstruction after APRE can reduce the rate of perineal wound complications. Furthermore, neoadjuvant treatment was shown to carry a major risk for wound complications. Patients after radio-/chemotherapy should undergo a primary reconstruction to prevent procedure-related perioperative morbidity. Subsequently, delays in adjuvant therapy, and prolonged hospital stay can be inhibited. Moreover, quality of life can be increased. The interdisciplinary approach aims at identifying high-risk patients for perineal wound complications who may benefit from primary reconstruction in order to reduce rate of wound complications with potential impact on rate of local recurrence. All these measures contribute to an optimized surgical standard.
直肠或肛管超低位肿瘤的多模式治疗方案包括化疗、根治性腹会阴联合切除术和/或放疗。一期伤口缝合会增加会阴伤口并发症的风险，而这些并发症需要二次修复。会阴伤口并发症可能会导致邻近肿瘤治疗的延迟，从而影响直肠癌的局部复发率和长期生存率。同时进行会阴缺损的一期重建已被证明可以降低会阴伤口并发症的发生率以及缩短住院时间，这使得能够及时进行邻近治疗，并可能改善预后。
本研究旨在通过比较有和没有一期会阴重建的两组患者，回顾性评估腹会阴联合切除术后的伤口并发症。在2005年至2011年期间，对患者进行分析并分为队列1和队列2。队列1包括33例未进行一期会阴重建的患者。队列2包括4例进行了一期会阴重建的患者。确定了伤口并发症增加和邻近治疗延迟的危险因素。
亚组分析显示，队列1的33例患者中有18例出现伤口并发症。在5例患者中，伤口愈合延长导致邻近治疗延迟。4例患者出现肿瘤进展，这4例患者中有2例有邻近治疗延迟的病史。术后并发症导致伤口愈合延长的主要危险因素是新辅助治疗史，发生率为64.7%。进行一期重建的队列2未出现伤口并发症或辅助治疗延迟。
腹会阴联合切除术后进行一期会阴重建可以降低会阴伤口并发症的发生率。此外，新辅助治疗被证明是伤口并发症的主要风险因素。接受放疗/化疗后的患者应进行一期重建，以预防手术相关的围手术期发病率。随后，可以避免辅助治疗的延迟和住院时间的延长。此外，还可以提高生活质量。多学科方法旨在识别可能从一期重建中受益的会阴伤口并发症高危患者，以降低伤口并发症的发生率，这可能会对局部复发率产生影响。所有这些措施都有助于优化手术标准。
