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Flap Coverage after Abdominoperineal Excision for Rectal Adenocarcinoma May Not Decrease Wound Dehis
Alexander T. Hawkins, MD, MPH; David L. Berger, MD; Paul C. Shellito, MD; Patrica Sylla, MD; Matthew M. Hutter, MD, MPH; Liliana Bordeianou, MD, MPH
Massachusetts General Hospital, Department of Surgery, Boston, MA

Background: Abdominoperineal Excision (APE) for rectal adenocarcinoma is associated with high morbidity, including perineal wound dehiscence. Recent trends toward extra-levator excisions (ELAPE) will likely only increase wound complications. Our goal was to evaluate impact of flap coverage in patients with rectal adenocarcinoma treated with APE.

Methods: The ACS 2005-2010 NSQIP database was used to determine the 30-day morbidity of patients undergoing APE for rectal adenocarcinoma. Univariate logistic regression was used to assess significance of predictive variables for 30-day mortality and morbidity. Separate multivariate logistic regression analysis was then performed for each outcome adjusting for all independently predictive risk factors.

Results: 2,180 APEs for rectal adenocarcinoma were identified. The mean age was 63.8 13.2 and 781 (35.8%) were female. 70 (3.2%) patients had APEs with flap reconstruction of the perineum. Patients undergoing flap coverage were younger, more likely to be female, less likely to be obese, and were more likely to have undergone pre-operative radiotherapy. Mean operative duration was longer in the flap group (452 vs 241 min; P< 0.001). 30-day wound complication rate was 20.5% and the rate of wound dehiscence was 2.8%. After adjustment, the odds of wound dehiscence were increased in the flap group (OR 3.26, 95% CI 1.30-9.19, P=0.01).

Conclusion:s: Even after adjusting for preoperative factors, patients receiving flap coverage with APE for rectal adenocarcinoma had higher odds of wound dehiscence. This data suggests that surgeons cannot compensate for wider ELAPEs with flap coverage alone.

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