From the Departments of Surgery and Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center; the Department of Plastic Surgery, Leiden University Medical Center; and the Department of Gastrointestinal Surgery, Ghent University Hospital.
Plast Reconstr Surg. 2021 Jun 1;147(6):1420-1435. doi: 10.1097/PRS.0000000000007976.
The treatment of locally advanced or recurrent anorectal cancer requires radical surgery such as extralevator abdominoperineal resection and pelvic exenteration. Larger defects require flap reconstruction. The authors evaluated outcomes of different perineal reconstruction techniques.
A systematic search was performed in the PubMed, Embase, and Cochrane databases. Studies reporting outcomes on perineal flap reconstruction in patients with anal or colorectal cancer were included. Data on patient characteristics, surgical details, perineal and donor-site complications, revision surgery, mortality, and quality of life were extracted. Articles were assessed using the Group Reading Assessment and Diagnostic Evaluation approach.
The authors included 58 mainly observational studies comprising 1988 patients. Seventy-three percent of patients had rectal cancer. The majority of 910 abdominoperineal resection patients underwent reconstruction with rectus abdominis flaps (91 percent). Dehiscence (15 to 32 percent) and wound infection (8 to 16 percent) were the most common complications. Partial flap necrosis occurred in 2 to 4 percent and flap loss occurred in 0 to 2 percent. Perineal herniation was seen in 6 percent after gluteal flap reconstruction and in 0 to 1 percent after other types of reconstruction. Donor-site complications were substantial but were reported inconsistently.
Clinical outcome data on perineal reconstruction after exenterative surgery are mostly of very low quality. Perineal reconstruction after pelvic exenteration is complex and requires a patient-tailored approach. Primary defect size, reconstruction aims, donor-site availability, and long-term morbidity should be taken into account. This review describes the clinical outcomes of four flap reconstruction techniques. Shared clinical decision-making on perineal reconstruction should be based on these present comprehensive data.
局部晚期或复发性肛门直肠癌的治疗需要根治性手术，如经肛提肌外腹会阴联合切除术和骨盆脏器切除术。较大的缺损需要皮瓣重建。作者评估了不同会阴重建技术的结果。
在 PubMed、Embase 和 Cochrane 数据库中进行了系统检索。纳入了报告肛门或结直肠癌患者会阴皮瓣重建结果的研究。提取了患者特征、手术细节、会阴和供区并发症、翻修手术、死亡率和生活质量的数据。使用 Group Reading Assessment and Diagnostic Evaluation 方法评估文章。
作者纳入了 58 项主要观察性研究，共 1988 例患者。73%的患者患有直肠癌。大多数 910 例腹会阴联合切除术患者接受了腹直肌皮瓣重建（91%）。裂开（15%至 32%）和伤口感染（8%至 16%）是最常见的并发症。部分皮瓣坏死发生率为 2%至 4%，皮瓣丢失发生率为 0%至 2%。臀肌皮瓣重建后会阴疝发生率为 6%，其他类型重建后发生率为 0%至 1%。供区并发症较多，但报告不一致。
盆腔脏器切除术后会阴重建的临床结果数据大多质量非常低。骨盆脏器切除术后的会阴重建较为复杂，需要个体化的方法。应考虑原发缺损大小、重建目的、供区可用性和长期发病率。本综述描述了四种皮瓣重建技术的临床结果。基于这些全面的数据，应进行会阴重建的共同临床决策。
