Tailored concept for the plastic closure of pelvic defects resulting from extralevator abdominoperineal excision (ELAPE) or pelvic exenteration View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2022-06-25

AUTHORS

Julia Jackisch, Thomas Jackisch, Joerg Roessler, Anja Sims, Holger Nitzsche, Pia Mann, Sören Torge Mees, Sigmar Stelzner

ABSTRACT

PurposeNo standard exists for reconstruction after extralevator abdominoperineal excision (ELAPE) and pelvic exenteration. We propose a tailored concept with the use of bilateral gluteal V–Y advancement flaps in non-extended ELAPE and with vertical myocutaneous rectus abdominis muscle (VRAM) flaps in extended procedures. This retrospective study analyzes the feasibility of this concept.Patients and methodsWe retrieved all consecutive patients after ELAPE or pelvic exenteration for rectal, anal, or vulva cancer with flap repair from a prospective database. Perineal wound complications were defined as the primary endpoint. Outcomes for the two different flap reconstructions were analyzed.ResultsFrom 2005 to 2021, we identified 107 patients who met the study criteria. Four patients underwent exenteration with VRAM flap repair after previous V–Y flap fashioning. Therefore, we report on 75 V–Y and 36 VRAM flaps. The V–Y group contained more rectal carcinomas, and the VRAM group exhibited more patients with recurrent cancer, more multivisceral resections, and longer operation times. Perineal wound complications occurred in 21.3% in the V–Y group and in 36.1% in the VRAM group (p = 0.097). Adjusted odds ratio for perineal wound complication was not significantly different for the two flap types.ConclusionConcerning perineal wound complications, our concept yields favorable results for V–Y flap closure indicating that this less invasive approach is sufficient for non-extended ELAPE. Advantages are a shorter operation time, less donor site morbidity, and the option of a second repair. VRAM flaps were reserved for larger wounds after pelvic exenteration or vaginal repair. More... »

PAGES

1669-1679

References to SciGraph publications

  • 2015-08-06. Persistent perineal morbidity is common following abdominoperineal excision for rectal cancer in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2018-06-01. Extended pelvic resection for rectal and anal canal tumors is a significant risk factor for perineal wound infection: a retrospective cohort study in SURGERY TODAY
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  • 2015-08-28. Real world dehiscence rates for patients undergoing abdominoperineal resection with or without myocutaneous flap closure in the national surgical quality improvement project in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2005-02-03. Rectus Flap Reconstruction Decreases Perineal Wound Complications After Pelvic Chemoradiation and Surgery: A Cohort Study in ANNALS OF SURGICAL ONCOLOGY
  • 2016-09-09. Long-term outcome of extralevator abdominoperineal excision (ELAPE) for low rectal cancer in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2014-04-22. A hundred patients with vertical rectus abdominis myocutaneous (VRAM) flap for pelvic reconstruction after total pelvic exenteration in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2009-01-01. Perineal Healing and Survival After Anal Cancer Salvage Surgery: 10-Year Experience with Primary Perineal Reconstruction Using the Vertical Rectus Abdominis Myocutaneous (VRAM) Flap in ANNALS OF SURGICAL ONCOLOGY
  • 2014-02-13. Impact of Flap Reconstruction on Perineal Wound Complications Following Ablative Surgery for Advanced and Recurrent Rectal Cancers in ANNALS OF SURGICAL ONCOLOGY
  • 2014-07-27. Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2014-06-21. Extralevator abdominoperineal excision (ELAPE) for rectal cancer—short-term results from the Swedish Colorectal Cancer Registry. Selective use of ELAPE warranted in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2017-11-02. Reparatur der perinealen Hernie in COLOPROCTOLOGY
  • 2013-02-26. Perineal reconstruction after extra-levator abdominoperineal excision (eLAPE): a systematic review in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00384-022-04196-6

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    http://dx.doi.org/10.1007/s00384-022-04196-6

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1148945319

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/35750763


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    30 schema:description PurposeNo standard exists for reconstruction after extralevator abdominoperineal excision (ELAPE) and pelvic exenteration. We propose a tailored concept with the use of bilateral gluteal V–Y advancement flaps in non-extended ELAPE and with vertical myocutaneous rectus abdominis muscle (VRAM) flaps in extended procedures. This retrospective study analyzes the feasibility of this concept.Patients and methodsWe retrieved all consecutive patients after ELAPE or pelvic exenteration for rectal, anal, or vulva cancer with flap repair from a prospective database. Perineal wound complications were defined as the primary endpoint. Outcomes for the two different flap reconstructions were analyzed.ResultsFrom 2005 to 2021, we identified 107 patients who met the study criteria. Four patients underwent exenteration with VRAM flap repair after previous V–Y flap fashioning. Therefore, we report on 75 V–Y and 36 VRAM flaps. The V–Y group contained more rectal carcinomas, and the VRAM group exhibited more patients with recurrent cancer, more multivisceral resections, and longer operation times. Perineal wound complications occurred in 21.3% in the V–Y group and in 36.1% in the VRAM group (p = 0.097). Adjusted odds ratio for perineal wound complication was not significantly different for the two flap types.ConclusionConcerning perineal wound complications, our concept yields favorable results for V–Y flap closure indicating that this less invasive approach is sufficient for non-extended ELAPE. Advantages are a shorter operation time, less donor site morbidity, and the option of a second repair. VRAM flaps were reserved for larger wounds after pelvic exenteration or vaginal repair.
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    48 bilateral gluteal
    49 cancer
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    51 closure
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    67 flap closure
    68 flap reconstruction
    69 flap repair
    70 flap type
    71 gluteal
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    75 less donor site morbidity
    76 longer operation time
    77 morbidity
    78 more patients
    79 multivisceral resection
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    81 odds ratio
    82 operation time
    83 options
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    86 pelvic defects
    87 pelvic exenteration
    88 perineal wound complications
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    93 ratio
    94 reconstruction
    95 rectal carcinoma
    96 rectus abdominis muscle flap
    97 recurrent cancer
    98 repair
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