title: Wound complications in rectal cancer patients undergoing primary closure of the perineal wound after abdominoperineal resection.
abstract: OBJECTIVE
  Perineal wound complications have a significant impact on postoperative morbidity after excision of the rectum and anus. The aim of this study is to evaluate factors affecting perineal wound complications after primary closure of the wound following abdominoperineal resection.
  
  
  METHODS
  Data were reviewed from all patients who underwent abdominoperineal resection for rectal carcinoma between 1982 and 2007. Data pertaining to demographics, tumor characteristics, and use of preoperative neoadjuvant therapy were retrieved. Complications studied included delayed wound healing, wound infection, dehiscence, abscess or sinus, reoperation, and perineal hernias. Patients who developed perineal wound complications (Group A) were compared with the remaining patients (Group B) to evaluate factors associated with the development of perineal wound complications.
  
  
  RESULTS
  Six hundred ninety-six patients (59% male) met the inclusion criteria. The mean age was 63 years (standard deviation, 13), and the mean body mass index was 28.9 kg/m2 (standard deviation, 7.8). Two hundred seventy-three patients (39.2%) received neoadjuvant chemoradiation. The overall rate of wound complications was 16.2%, and reoperation was required in 5.2% of patients. Group A and Group B patients were similar with respect to age (P = 0.1), gender (P = 0.7), grade (P = 0.4), and stage of disease (P = 0.5). A greater proportion of Group A patients had associated comorbidity (P = 0.001), obesity (0.04), neoadjuvant chemoradiation (0.02), and intraoperative bleeding (0.04). In multivariate analysis, comorbidity was the only independent factor associated with the development of perineal complications (odds ratio, 1.8 (1.09-2.96)).
  
  
  CONCLUSIONS
  Most patients have perineal wound healing without complications after abdominoperineal resection. In multivariate analysis, comorbidity was the only significant factor that predicted perineal wound complications.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Galal
authors.initials: G
authors.lastname: El-Gazzaz
authors.forename: Ravi Pokala
authors.initials: RP
authors.lastname: Kiran
authors.forename: Ian
authors.initials: I
authors.lastname: Lavery
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery* / Q000628:therapy; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010502:Perineum / Q000601:surgery*; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D012307:Risk Factors; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection; D014945:Wound Healing / Q000528:radiation effects