title: Risk factors for perineal wound infection after abdominoperineal resection of advanced lower rectal cancer.
abstract: OBJECTIVE
  Abdominoperineal resection (APR) of advanced lower rectal cancer carries a high incidence of perineal wound infection. The aim of this study was to retrospectively evaluate risk factors for perineal wound infection after APR.
  
  
  METHODS
  The study group comprised 154 patients who underwent APR for advanced lower rectal cancer in our department from January 1990 through December 2012. The following 15 variables were studied as potential risk factors for perineal wound infection: sex, age, body-mass index, American Society of Anesthesiologists score, diabetes mellitus, preoperative albumin level, preoperative hemoglobin level, neoadjuvant chemoradiotherapy(NCRT), surgical procedure (open surgery vs. laparoscopic surgery), operation time, bleeding volume, intraoperative transfusion, tumor diameter, invasion depth, and histopathological stage.
  
  
  RESULTS
  Among the 154 patients, 30 (19%) had perineal wound infection. Univariate analysis showed that a hemoglobin level of ≤11 g/dL (p = 0.001) and NCRT (p = 0.001) were significantly related to perineal wound infection. On multivariate analysis including the preoperative albumin level (≤3.5 g/dL) in addition to the above 2 variables, neoadjuvant chemoradiotherapy (NCRT) was the only independent risk factor for perineal wound infection. Perineal wound infection developed in 31% of patients who received NCRT, as compared with 10% of patients who did not receive NCRT. The relative risk of perineal infection in the former group was 4.092 as compared with the latter group (p = 0.0002).
  
  
  CONCLUSIONS
  NCRT is a risk factor for perineal wound infection after APR in patients with advanced lower rectal cancer.
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Radiology and Radiation Oncology, Kitasato University Hospital, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Hayakawa
authors.affiliation: Department of Infection Control and Infectious Diseases Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Takayama
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Naito
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamanashi
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Tsutsui
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Miura
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
keywords: APR, Abdominoperineal resection; Advanced; NCRT, Neoadjuvant chemoradiotherapy; Neoadjuvant chemoradiotherapy; Perineal wound infection; Rectal cancer