title: Prevention of severe pelvic abscess formation following extended radical surgery for locally recurrent rectal cancer.
abstract: BACKGROUND
  For treatment of locally recurrent rectal cancer (LRRC), extended radical surgery is sometimes required to obtain a negative margin. Such surgery is often associated with severe postoperative pelvic abscess (PA) formation. The aim of this study was to determine the effects of reconstructive surgery using a large rectus abdominis myocutaneous (RAM) flap and anal preservation surgery on the incidence of severe PA.
  
  
  METHODS
  Between February 1998 and June 2008, 44 patients underwent extended surgery for LRRC. Patients were divided into the pre-2004 group (n = 15) and the post-2004 group (n = 29). To reduce the risk of infections, we modified the surgical approach after 2004 to include a larger volume of RAM flap (modified RAM flap) and implemented anal preservation surgery.
  
  
  RESULTS
  The overall incidence of severe PA was significantly lower in the post-2004 group [6 of 29 (21%)] than the pre-2004 group [9 of 15 (60%), P = 0.017]. The incidence of severe PA was lower in the anal preservation group [1 of 12 (8.3%)] compared with those who did not undergo such surgery [14 of 32 (44%), P = 0.035]. Modified RAM flap reduced the incidence of severe PA, albeit insignificantly (pre-2004 group: 57%, post-2004 group: 23%). All three patients who underwent anal preservation and modified RAM flap reconstruction did not develop severe PA. Multiple logistic analysis identified no anal preservation (Odds ratio [OR] = 10.6) and performing of sacrectomy (OR = 20.0) as risk factors for severe PA.
  
  
  CONCLUSIONS
  Anal preservation surgery is an effective measure against the development of severe PA after radical resection of LRRC.
authors.affiliation: Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Uemura
authors.forename: Masataka
authors.initials: M
authors.lastname: Ikeda
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Naotsugu
authors.initials: N
authors.lastname: Haraguchi
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Mizushima
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takemasa
authors.forename: Hideshi
authors.initials: H
authors.lastname: Ishii
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000038:Abscess / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D034161:Pelvic Infection / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D014945:Wound Healing