Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis
Background. Abdominoperineal resection (APR) and pelvic exenteration (PE) for the treatment of cancer require extensive pelvic resection with a high rate of postoperative complications. The objective of this work was to systematically review and meta-analyze the effects of vertical rectus abdominis...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-02-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/4/721 |
| _version_ | 1797411841885863936 |
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| author | Etienne Buscail Cindy Canivet Jason Shourick Elodie Chantalat Nicolas Carrere Jean-Pierre Duffas Antoine Philis Emilie Berard Louis Buscail Laurent Ghouti Benoit Chaput |
| author_facet | Etienne Buscail Cindy Canivet Jason Shourick Elodie Chantalat Nicolas Carrere Jean-Pierre Duffas Antoine Philis Emilie Berard Louis Buscail Laurent Ghouti Benoit Chaput |
| author_sort | Etienne Buscail |
| collection | DOAJ |
| description | Background. Abdominoperineal resection (APR) and pelvic exenteration (PE) for the treatment of cancer require extensive pelvic resection with a high rate of postoperative complications. The objective of this work was to systematically review and meta-analyze the effects of vertical rectus abdominis myocutaneous flap (VRAMf) and mesh closure on perineal morbidity following APR and PE (mainly for anal and rectal cancers). Methods. We searched PubMed, Cochrane, and EMBASE for eligible studies as of the year 2000. After data extraction, a meta-analysis was performed to compare perineal wound morbidity. The studies were distributed as follows: Group A comparing primary closure (PC) and VRAMf, Group B comparing PC and mesh closure, and Group C comparing PC and VRAMf in PE. Results. Our systematic review yielded 18 eligible studies involving 2180 patients (1206 primary closures, 647 flap closures, 327 mesh closures). The meta-analysis of Groups A and B showed PC to be associated with an increase in the rate of total (Group A: OR 0.55, 95% CI 0.43–0.71; <i>p</i> < 0.01/Group B: OR 0.54, CI 0.17–1.68; <i>p</i> = 0.18) and major perineal wound complications (Group A: OR 0.49, 95% CI 0.35–0.68; <i>p</i> < 0.001/Group B: OR 0.38, 95% CI 0.12–1.17; <i>p</i> < 0.01). PC was associated with a decrease in total (OR 2.46, 95% CI 1.39–4.35; <i>p</i> < 0.01) and major (OR 1.67, 95% CI 0.90–3.08; <i>p</i> = 0.1) perineal complications in Group C. Conclusions. Our results confirm the contribution of the VRAMf in reducing major complications in APR. Similarly, biological prostheses offer an interesting alternative in pelvic reconstruction. For PE, an adapted reconstruction must be proposed with specialized expertise. |
| first_indexed | 2024-03-09T04:52:08Z |
| format | Article |
| id | doaj.art-946de9a191134543b5cfcd69ff2f7cf3 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T04:52:08Z |
| publishDate | 2021-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-946de9a191134543b5cfcd69ff2f7cf32023-12-03T13:09:53ZengMDPI AGCancers2072-66942021-02-0113472110.3390/cancers13040721Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-AnalysisEtienne Buscail0Cindy Canivet1Jason Shourick2Elodie Chantalat3Nicolas Carrere4Jean-Pierre Duffas5Antoine Philis6Emilie Berard7Louis Buscail8Laurent Ghouti9Benoit Chaput10Department of Digestive Surgery, Toulouse University Hospital, 31100 Toulouse, FranceDepartment of Digestive Surgery, Toulouse University Hospital, 31100 Toulouse, FranceDepartment of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, University of Toulouse, 31100 Toulouse, FranceDepartment of Surgery, Oncopole, INSERM-UPS UMR U1048, Institute of Metabolic and Cardiovascular Diseases, University of Toulouse, 31100 Toulouse, FranceDepartment of Digestive Surgery, Toulouse University Hospital, 31100 Toulouse, FranceDepartment of Digestive Surgery, Toulouse University Hospital, 31100 Toulouse, FranceDepartment of Digestive Surgery, Toulouse University Hospital, 31100 Toulouse, FranceDepartment of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, University of Toulouse, 31100 Toulouse, FranceDepartment of Gastroenterology and Pancreatology, Toulouse University Hospital, 31100 Toulouse, FranceDepartment of Digestive Surgery, Toulouse University Hospital, 31100 Toulouse, FranceDepartment of Plastic and Reconstructive Surgery, Toulouse University Hospital, 31100 Toulouse, FranceBackground. Abdominoperineal resection (APR) and pelvic exenteration (PE) for the treatment of cancer require extensive pelvic resection with a high rate of postoperative complications. The objective of this work was to systematically review and meta-analyze the effects of vertical rectus abdominis myocutaneous flap (VRAMf) and mesh closure on perineal morbidity following APR and PE (mainly for anal and rectal cancers). Methods. We searched PubMed, Cochrane, and EMBASE for eligible studies as of the year 2000. After data extraction, a meta-analysis was performed to compare perineal wound morbidity. The studies were distributed as follows: Group A comparing primary closure (PC) and VRAMf, Group B comparing PC and mesh closure, and Group C comparing PC and VRAMf in PE. Results. Our systematic review yielded 18 eligible studies involving 2180 patients (1206 primary closures, 647 flap closures, 327 mesh closures). The meta-analysis of Groups A and B showed PC to be associated with an increase in the rate of total (Group A: OR 0.55, 95% CI 0.43–0.71; <i>p</i> < 0.01/Group B: OR 0.54, CI 0.17–1.68; <i>p</i> = 0.18) and major perineal wound complications (Group A: OR 0.49, 95% CI 0.35–0.68; <i>p</i> < 0.001/Group B: OR 0.38, 95% CI 0.12–1.17; <i>p</i> < 0.01). PC was associated with a decrease in total (OR 2.46, 95% CI 1.39–4.35; <i>p</i> < 0.01) and major (OR 1.67, 95% CI 0.90–3.08; <i>p</i> = 0.1) perineal complications in Group C. Conclusions. Our results confirm the contribution of the VRAMf in reducing major complications in APR. Similarly, biological prostheses offer an interesting alternative in pelvic reconstruction. For PE, an adapted reconstruction must be proposed with specialized expertise.https://www.mdpi.com/2072-6694/13/4/721rectal cancerabdominoperineal resectionflapmeshperineal wound healingperineal morbidity |
| spellingShingle | Etienne Buscail Cindy Canivet Jason Shourick Elodie Chantalat Nicolas Carrere Jean-Pierre Duffas Antoine Philis Emilie Berard Louis Buscail Laurent Ghouti Benoit Chaput Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis Cancers rectal cancer abdominoperineal resection flap mesh perineal wound healing perineal morbidity |
| title | Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis |
| title_full | Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis |
| title_fullStr | Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis |
| title_short | Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis |
| title_sort | perineal wound closure following abdominoperineal resection and pelvic exenteration for cancer a systematic review and meta analysis |
| topic | rectal cancer abdominoperineal resection flap mesh perineal wound healing perineal morbidity |
| url | https://www.mdpi.com/2072-6694/13/4/721 |
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