[Risk factors for the perineal incision complications after abdominoperineal excision for rectal cancer].
OBJECTIVE
To evaluate the factors affecting perineal incision complications after abdominperineal excision(APE) for rectal cancer.


METHODS
This was a retrospective study of 167 patients with rectal cancer undergoing APE at Peking University People's Hospital between October 1998 and December 2013. Chi-square test and multivariate Logistic regression analysis were used to identify risk factors.


RESULTS
The overall rate of perineal incision complication was 24.6%(41/167) including 7 cases of incision infection, 10 cases of incision fat liquefaction, 21 cases of poor wound healing, 2 cases of incision fistula, 1 case of incision dehiscence. In univariate analysis, the risk factors associated with perineal incision complication were operating time≥280 minutes(P=0.005), blood loss≥350 ml(P=0.017) and the protective factors associated with perineal incision complication were the procedure of APE (P=0.048), intraperitoneal chemotherapy with 5-FU sustained release (P=0.014), lymph node metastasis (P=0.006), while gender, age, BMI, ASA score, other complications, distance from distal tumor to anal verge, preoperative radiochemotherapy, postoperative stay in ICU, total drainage volume 3 days before operation, tumor differentiation, and postoperative TNM staging were not associated with perineal incision complication(all P>0.05). Multivariate logistic regression analysis identified two independent risk factors: operating time≥280 minutes(OR=5.217, 95% CI:1.250 - 6.234, P=0.000), intraperitoneal chemotherapy with 5-FU sustained release(OR=3.284, 95% CI:1.156 - 9.334, P=0.026).


CONCLUSIONS
Operating time≥280 minutes and intraperitoneal chemotherapy with 5-FU sustained release are independent risk factors for perineal incision complications after APE for rectal cancer. For patients receiving APE procedure, intraperitoneal chemotherapy with 5-FU sustained release should be used with caution, and the operative time should be reduced when possible.
Chao
C
Wang
Chang
C
Wang
Zhidong
Z
Gao
Bin
B
Liang
Xiaodong
X
Yang
Mujun
M
Yin
Kewei
K
Jiang
Qiwei
Q
Xie
Shan
S
Wang
Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China. yeyingjiang@pkuph.edu.cn.
Yingjiang
Y
Ye
Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China. rmyyguopeng@163.com.
Peng
P
Guo
D000005:Abdomen / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D009367:Neoplasm Staging; D061646:Operative Time; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology