title: Persistent perineal morbidity is common following abdominoperineal excision for rectal cancer.
abstract: OBJECTIVE
  Short-term complications related to the perineal wound after abdominoperineal excision (APE) are a well-known problem. Perineal morbidity in the longer term is an almost unexplored area. The aim of this cross-sectional study was to investigate the prevalence of perineal symptoms 3 years after APE for rectal cancer, to identify potential risk factors and to explore the relationship between perineal morbidity and global quality of life.
  
  
  METHODS
  All patients who underwent APE in Sweden between 2007 and 2009 (n = 1373) were identified through the Swedish Colorectal Cancer Registry. Surviving patients were contacted 3 years after surgery and asked about participation. A total of 545 patients completed a detailed questionnaire. Clinical data was collected from the registry and surgical charts.
  
  
  RESULTS
  Perineal symptoms occurred in 50 % of all patients 3 years after APE and more frequently in women (58 vs. 44 %; p = 0.001). Delayed healing of the perineal wound (>4 weeks) occurred in 25 % of all patients and more frequently after extralevator APE (ELAPE) than after conventional APE (32 vs. 11 %, p < 0.001). Delayed healing was associated with an increased risk of more severe perineal symptoms (relative risk (RR) 1.50, 95 % confidence interval (95 % CI) 1.09-2.05). Patients with more severe perineal symptoms (n = 129) had a significantly lower global quality of life as measured by EQ-5D visual analogue scale (VAS; median 75 vs. 83 points on the 100-point scale; p < 0.001).
  
  
  CONCLUSIONS
  Persistent perineal symptoms are common after APE and may have an impact on patients' quality of life. Delayed wound healing may be a risk factor for persistent symptoms. Further studies are needed to identify avoidable clinical factors for the development of persistent perineal morbidity. CLINICALTRIALS.
  NCT01296984.
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, 416 85, Gothenburg, Sweden. dan.asplund@vgregion.se.
authors.forename: Dan
authors.identifier: http://orcid.org/0000-0003-1758-8480
authors.initials: D
authors.lastname: Asplund
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, 416 85, Gothenburg, Sweden.|Department of Surgery, NU Hospital group, Trollhättan, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Prytz
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, 416 85, Gothenburg, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Bock
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, 416 85, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Haglind
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, 416 85, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Angenete
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014945:Wound Healing
keywords: Abdominoperineal excision; Perineal morbidity; Quality of life; Rectal cancer