title: Wound dehiscence after abdominoperineal resection for low rectal cancer is associated with decreased survival.
abstract: BACKGROUND
  Abdominoperineal resection for low rectal adenocarcinoma is a common procedure with high morbidity, including perineal wound complications.
  
  
  OBJECTIVE
  The purpose of this study was to determine risk factors for perineal wound dehiscence and to investigate the effect of wound dehiscence on survival.
  
  
  METHODS
  This was a retrospective medical chart review.
  
  
  METHODS
  The study was conducted in a tertiary care university medical center.
  
  
  METHODS
  Patients included in the study were those with low rectal adenocarcinoma who underwent abdominoperineal resection between January 2001 and June 2012.
  
  
  METHODS
  We assessed the incidence of perineal wound dehiscence, as well as survival, after surgery.
  
  
  RESULTS
  A total of 249 patients underwent abdominoperineal resection for rectal carcinoma. The mean age was 62.6 years (range, 23.0-98.0 years), 159 (63.8%) were male, and the mean BMI was 27.9 (range, 16.7-58.5). There were 153 patients (61.1%) who survived for 5 years after surgery. Sixty-nine patients (27.7%) developed wound dehiscence. Multivariable analysis revealed the following associations with dehiscence: BMI (OR, 1.09; 95% CI, 1.03-1.15; p = 0.002), IBD (OR, 6.6; 95% CI, 1.4-32.5; p = 0.02), history of other malignant neoplasm (OR, 3.1; 95% CI, 1.5-6.6), and abdominoperineal resection for cancer recurrence (OR, 2.8; 95% CI, 1.2-6.3; p = 0.01). In the survival analysis, wound dehiscence was associated with decreased survival (mean survival time for dehiscence vs no dehiscence, 66.6 months vs 76.6 months; p = 0.01). This relationship persisted in the multivariable analysis (HR, 1.7; 95% CI, 1.1-2.8; p = 0.02).
  
  
  CONCLUSIONS
  This was a retrospective, observational study from a single center.
  
  
  CONCLUSIONS
  The adjusted risk of death was 1.7 times higher in patients who experienced dehiscence than in those who did not. Attention to perineal wound closure with consideration of flap creation should at least be given to patients with a history of malignant neoplasm, those with IBD, those with rectal cancer recurrence, and women undergoing posterior vaginectomy. Preoperative weight loss should also reduce dehiscence risk.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hawkins
authors.forename: David L
authors.initials: DL
authors.lastname: Berger
authors.forename: Paul C
authors.initials: PC
authors.lastname: Shellito
authors.forename: Patrica
authors.initials: P
authors.lastname: Sylla
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
mesh_terms: D000005:Abdomen / Q000601:surgery; D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000401:mortality* / Q000473:pathology; D055815:Young Adult