Reconstruction of perineal wound and pelvic floor after extralevator abdominoperineal excision of the rectum: a novel solution to the problem (results of a multicenter randomized study)

AIM: to improve the outcomes of perineal wound reconstruction after ELAPE for low rectal cancer by applying a new reconstructive technique.

PATIENTS AND METHODS: a cohort multicenter randomized controlled trial included 150 patients, allocated into three groups depending on the perineal wound reconstruction technique: new technique (n = 50), simple wound closure (n = 50), mesh repair (n = 50). The time of the reconstruction stage, blood loss, pain intensity, frequency of early (up to 30 days) (seroma, hematoma, suppuration, flap necrosis) and late (median 14 months) postoperative complications (fistulas, abscesses, perineal hernias, chronic pain syndrome) were studied; patient quality of life was assessed.

RESULTS: the time of the reconstruction stage was longer in the new technique group (50 [45; 55] min) compared to 20 [20; 25] min for simple closure and 35 [30; 40] min for mesh repair (p < 0.0001). Pain intensity on days 1, 3, and 5 was lower in the new reconstruction technique group (p = 0.005, p = 0.002, p = 0.0007). The frequency of early complications was 16% in the new technique group versus 32% and 24% in the comparison groups (p = 0.17). The differences were not statistically significant. Wound suppuration developed in 2 (4%) vs. 8 (16%) and 5 (10%), p = 0.43. Late complications were recorded in 2% of patients in the new reconstruction group versus 14% in each of the comparison groups (p = 0.07). The rate of chronic fistulas (0, 2 (4%), 4 (8%), p = 0.22), perineal hernia (1 (2%), 4 (8%), 3 (6%), p = 0.22). Quality of life indicators were significantly better in the new reconstruction group (p < 0.0001).

CONCLUSIONS: perineal wound reconstruction using the new technique after ELAPE for rectal cancer requires more time, but it provides reduced postoperative pain intensity, improved quality of life, and demonstrates a clinically significant trend towards reducing the frequency of early and late postoperative complications.

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