Prevention of severe pelvic abscess formation following extended radical surgery for locally recurrent rectal cancer.
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.
Uemura
Mamoru
M
Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Ikeda
Masataka
M
Sekimoto
Mitsugu
M
Haraguchi
Naotsugu
N
Mizushima
Tsunekazu
T
Yamamoto
Hirofumi
H
Takemasa
Ichiro
I
Ishii
Hideshi
H
Mori
Masaki
M
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