Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis USA; Department of Surgery, Division of Colon & Rectal Surgery, University of California, Davis USA.
Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis USA; Department of Surgery, Division of Colon & Rectal Surgery, University of California, Davis USA; Department of Public Health Sciences, Division of Biostatistics, University of California, Davis USA.
J Plast Reconstr Aesthet Surg. 2021 Sep;74(9):2085-2094. doi: 10.1016/j.bjps.2020.12.067. Epub 2021 Jan 9.
Flap reconstruction of radiated pelvic oncologic defects decreases perineal wound-healing complications. How widely and how often reconstructions are performed, and how technical mastery and improved perioperative care has affected outcomes, is unknown. Our objective is to 1) provide a comprehensive evaluation of national trends in flap reconstruction of pelvic oncologic defects and 2) compare complications and length of stay (LOS) in patients with/without reconstruction.
The National Inpatient Sample (NIS) database was queried (1998-2014) for patients diagnosed with cancer, primarily of the rectum and anus, who underwent abdominoperineal resection (APR) or pelvic exenteration (PE). Differences in complications and LOS were compared between patients with flap reconstruction versus primary closure. Regional and hospital outcomes were also analyzed.
The cohort included 117,923 adult patients; 3,673 (3.1%) underwent flap reconstruction. Flap reconstruction rates increased from 0.8% in 1998 to 9.8% in 2014. Extirpative procedures decreased 37.4% from 1998 to 2014. Flap reconstruction decreased risk of wound breakdown (OR 0.87; p = 0.0029) and need for secondary closure of dehiscence (OR 0.82; p = 0.0023) between periods 1998-2009 and 2010-2014. Median LOS was higher for flap patients (median [IQR] of 9.8 [7.2,14.8] vs. 7.9 [6.1-11.0; p < 0.0001) and decreased over time.
The use of flap reconstruction for pelvic oncologic defects increased from 1998 to 2014, with a reduction in LOS. Following flap reconstruction, overall complications are higher, but wound breakdown and dehiscence requiring reclosure are decreasing, suggesting technique maturation. We anticipate flap reconstruction rates will increase with further improvement in patient outcomes.
皮瓣重建可减少放射性骨盆肿瘤缺损患者的会阴伤口愈合并发症。但目前尚不清楚皮瓣重建术的应用范围有多广、频率有多高，以及技术掌握和围手术期护理的改进如何影响手术结果。我们的目的是：1）全面评估全国范围内骨盆肿瘤缺损皮瓣重建的趋势；2）比较有和无皮瓣重建患者的并发症和住院时间（length of stay，LOS）。
我们对 1998 年至 2014 年间在国家住院患者样本（National Inpatient Sample，NIS）数据库中诊断患有直肠癌和肛门癌并接受腹会阴联合切除术（abdominoperineal resection，APR）或盆腔脏器切除术（pelvic exenteration，PE）的患者进行了检索。比较皮瓣重建组与直接缝合组患者的并发症和 LOS 差异。还分析了区域和医院结局。
该队列包括 117923 名成年患者；其中 3673 名（3.1%）接受了皮瓣重建。1998 年皮瓣重建率为 0.8%，2014 年增加至 9.8%。同期，根治性手术减少了 37.4%。与 1998 年至 2009 年相比，2010 年至 2014 年期间，皮瓣重建降低了伤口破裂（OR 0.87；p=0.0029）和需要二次缝合裂开（OR 0.82；p=0.0023）的风险。皮瓣组的 LOS 中位数较高（9.8[7.2，14.8]比 7.9[6.1-11.0]；p<0.0001），且随时间推移逐渐降低。
1998 年至 2014 年间，骨盆肿瘤缺损皮瓣重建的应用逐渐增加，同时 LOS 逐渐缩短。皮瓣重建后，总体并发症发生率较高，但伤口破裂和需要再次缝合的裂开减少，表明技术逐渐成熟。我们预计，随着患者结局的进一步改善，皮瓣重建的比例将会增加。
