经腹会阴直肠癌切除术后行和不行网膜成形术的盆腔会阴发病率的倾向评分调整比较。

Propensity Score Adjusted Comparison of Pelviperineal Morbidity With and Without Omentoplasty Following Abdominoperineal Resection for Primary Rectal Cancer.

机构信息

Amsterdam UMC, University of Amsterdam, LEXOR, Center for Experimental and Molecular Medicine, Oncode Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands.

Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.

出版信息

Dis Colon Rectum. 2019 Aug;62(8):952-959. doi: 10.1097/DCR.0000000000001349.

DOI:10.1097/DCR.0000000000001349

PMID:30747743

Abstract

BACKGROUND

Abdominoperineal resection is associated with a high incidence of perineal complications, and whether this is reduced by an omentoplasty is still unclear.

OBJECTIVE

This study aimed to investigate the impact of omentoplasty on pelviperineal morbidity in patients undergoing abdominoperineal resection for rectal cancer.

DESIGN

This was a retrospective comparative cohort study using propensity score analyses to reduce potential confounding.

SETTING

The study was undertaken in 2 teaching hospitals and 1 university hospital.

PATIENTS

Patients who underwent abdominoperineal resection for primary rectal cancer between 2000 and 2017 were included.

MAIN OUTCOME MEASURES

The main end points were primary perineal wound healing at 30 days and overall and specific pelviperineal morbidity until the end of the study period.

RESULTS

Among 254 included patients, 106 had an omentoplasty. The primary perineal wound healing rate at 30 days was similar for omentoplasty and no omentoplasty (65% vs 60%; p = 0.422), also after adjusting for potential confounding by propensity score analysis (OR, 0.89; 95% CI, 0.45-1.75). Being free from any pelviperineal complication at 6 months (75% vs 79%; p = 0.492), absence of any pelviperineal morbidity until 1 year (54% vs 49%; p = 0.484), and incidence of persistent perineal sinus (6% vs 10%; p = 0.256) were also similar in both groups. The unadjusted higher perineal hernia rate after omentoplasty (18% vs 7%; p = 0.011) did not remain statistically significant after regression analysis including the propensity score (OR, 1.34; 95% CI, 0.46-3.88). Complications related to the omentoplasty itself were observed in 8 patients, of whom 6 required reoperation.

LIMITATIONS

This study was limited by the retrospective and nonrandomized design causing some heterogeneity between the 2 cohorts.

CONCLUSION

In this multicenter study using propensity score analyses, the use of omentoplasty did not lower the incidence or the duration of pelviperineal morbidity in patients undergoing abdominoperineal resection for rectal cancer, and omentoplasty itself was associated with a risk of reoperation. See Video Abstract at http://links.lww.com/DCR/A918.

摘要

背景

腹会阴联合切除术与较高的会阴并发症发生率相关，而是否通过网膜成形术降低这种风险仍不清楚。

目的

本研究旨在探讨在接受腹会阴联合切除术治疗直肠癌的患者中，网膜成形术对骨盆会阴发病率的影响。

设计

这是一项回顾性的比较队列研究，采用倾向评分分析来减少潜在的混杂因素。

设置

研究在 2 所教学医院和 1 所大学医院进行。

患者

纳入 2000 年至 2017 年间接受腹会阴联合切除术治疗原发性直肠癌的患者。

主要观察指标

主要终点是术后 30 天的原发性会阴伤口愈合情况，以及整个研究期间的总体和特定骨盆会阴发病率。

结果

在 254 例纳入的患者中，106 例行网膜成形术。术后 30 天的原发性会阴伤口愈合率在网膜成形术组和无网膜成形术组相似（65%比 60%；p=0.422），即使在经过倾向评分分析调整潜在混杂因素后也是如此（OR，0.89；95%CI，0.45-1.75）。在 6 个月时无任何骨盆会阴并发症（75%比 79%；p=0.492），在 1 年时无任何骨盆会阴发病率（54%比 49%；p=0.484），且持续性会阴窦道的发生率（6%比 10%；p=0.256）在两组中也相似。网膜成形术后未调整的会阴疝发生率较高（18%比 7%；p=0.011），但在包括倾向评分的回归分析中无统计学意义（OR，1.34；95%CI，0.46-3.88）。8 例患者出现与网膜成形术本身相关的并发症，其中 6 例需要再次手术。