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Short-term outcomes following beyond total mesorectal excision and reconstruction using myocutaneous flaps : A retrospective cohort study

Assi, Hanin LU ; Persson, Anna ; Palmquist, Ingrid LU ; Öberg, Martin LU ; Buchwald, Pamela LU and Lydrup, Marie Louise LU (2022) In European Journal of Surgical Oncology 48(5). p.1161-1166
Abstract

Introduction: Beyond total mesorectal excision (bTME) offers long-term survival in patients with advanced pelvic malignancy. At Skåne University Hospital (SUS) Malmö in Sweden, the vertical rectus abdominis musculocutaneous (VRAM) and gluteal maximus (GM) flap have been used for perineal reconstruction to promote healing and functional outcomes after significant tissue loss. This study aims to examine 90-day overall and flap-specific complications in patients with advanced pelvic cancer treated with bTME and perineal flap reconstruction. Method: This retrospective study conducted at SUS included patients undergoing surgery between January 01, 2010 and August 01, 2016. Patients’ data were gathered through medical chart reviews. The... (More)

Introduction: Beyond total mesorectal excision (bTME) offers long-term survival in patients with advanced pelvic malignancy. At Skåne University Hospital (SUS) Malmö in Sweden, the vertical rectus abdominis musculocutaneous (VRAM) and gluteal maximus (GM) flap have been used for perineal reconstruction to promote healing and functional outcomes after significant tissue loss. This study aims to examine 90-day overall and flap-specific complications in patients with advanced pelvic cancer treated with bTME and perineal flap reconstruction. Method: This retrospective study conducted at SUS included patients undergoing surgery between January 01, 2010 and August 01, 2016. Patients’ data were gathered through medical chart reviews. The Clavien-Dindo (CD) classification system was used to classify surgical and medical postoperative complications. Flap-specific complications were evaluated regardless of CD classification. Results: One hundred five patients (51 men, 54 women) underwent bTME surgery with perineal reconstruction, with VRAM flaps used in 27 (26%) patients, GM flaps in 51 (49%) patients and GM flaps with vaginal reconstruction in 27 (26%) patients. The 90-day mortality rate was one (1%), despite surgical CD ≥ III and/or medical CD ≥ II complications affecting 51 (48%) patients. Partial perineal dehiscence was noted in 45 (43%) patients, mostly treated conservatively. At the first outpatient postoperative visit (median, 42 days), flap healing was complete in 47 (45%) patients. Conclusion: bTME surgery in pelvic cancer patients with perineal flap reconstruction using VRAM or GM flaps results in high overall and flap complication rates, but low mortality. Most complications can be conservatively treated.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
bTME, Colorectal cancer, Complications, Myocutaneous flap, Perineal reconstruction
in
European Journal of Surgical Oncology
volume
48
issue
5
pages
1161 - 1166
publisher
Elsevier
external identifiers
  • pmid:34794841
  • scopus:85119597313
ISSN
0748-7983
DOI
10.1016/j.ejso.2021.11.001
language
English
LU publication?
yes
id
eb5dbe33-ef23-405c-9da0-dec43936994b
date added to LUP
2021-12-10 12:36:14
date last changed
2024-06-15 22:27:25
@article{eb5dbe33-ef23-405c-9da0-dec43936994b,
  abstract     = {{<p>Introduction: Beyond total mesorectal excision (bTME) offers long-term survival in patients with advanced pelvic malignancy. At Skåne University Hospital (SUS) Malmö in Sweden, the vertical rectus abdominis musculocutaneous (VRAM) and gluteal maximus (GM) flap have been used for perineal reconstruction to promote healing and functional outcomes after significant tissue loss. This study aims to examine 90-day overall and flap-specific complications in patients with advanced pelvic cancer treated with bTME and perineal flap reconstruction. Method: This retrospective study conducted at SUS included patients undergoing surgery between January 01, 2010 and August 01, 2016. Patients’ data were gathered through medical chart reviews. The Clavien-Dindo (CD) classification system was used to classify surgical and medical postoperative complications. Flap-specific complications were evaluated regardless of CD classification. Results: One hundred five patients (51 men, 54 women) underwent bTME surgery with perineal reconstruction, with VRAM flaps used in 27 (26%) patients, GM flaps in 51 (49%) patients and GM flaps with vaginal reconstruction in 27 (26%) patients. The 90-day mortality rate was one (1%), despite surgical CD ≥ III and/or medical CD ≥ II complications affecting 51 (48%) patients. Partial perineal dehiscence was noted in 45 (43%) patients, mostly treated conservatively. At the first outpatient postoperative visit (median, 42 days), flap healing was complete in 47 (45%) patients. Conclusion: bTME surgery in pelvic cancer patients with perineal flap reconstruction using VRAM or GM flaps results in high overall and flap complication rates, but low mortality. Most complications can be conservatively treated.</p>}},
  author       = {{Assi, Hanin and Persson, Anna and Palmquist, Ingrid and Öberg, Martin and Buchwald, Pamela and Lydrup, Marie Louise}},
  issn         = {{0748-7983}},
  keywords     = {{bTME; Colorectal cancer; Complications; Myocutaneous flap; Perineal reconstruction}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1161--1166}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Surgical Oncology}},
  title        = {{Short-term outcomes following beyond total mesorectal excision and reconstruction using myocutaneous flaps : A retrospective cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.ejso.2021.11.001}},
  doi          = {{10.1016/j.ejso.2021.11.001}},
  volume       = {{48}},
  year         = {{2022}},
}