Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer
Top Cited Papers
- 1 December 2006
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Surgery
- Vol. 94 (2), 232-238
- https://doi.org/10.1002/bjs.5489
Abstract
Background Intraoperative tumour perforation, positive tumour margins, wound complications and local recurrence are frequent difficulties with conventional abdominoperineal resection (APR) for rectal cancer. An alternative technique is the extended posterior perineal approach with gluteus maximus flap reconstruction of the pelvic floor. The aim of this study was to report the technique and early experience of extended APR in a select cohort of patients. Methods The principles of operation are that the mesorectum is not dissected off the levator muscles, the perineal dissection is done in the prone position and the levator muscles are resected en bloc with the anus and lower rectum. The perineal defect is reconstructed with a gluteus maximus flap. Between 2001 and 2005, 28 patients with low rectal cancer were treated accordingly at the Karolinska Hospital. Results Two patients had ypT0 tumours, 20 ypT3 and six ypT4 tumours. Bowel perforation occurred in one, the circumferential resection margin (CRM) was positive in two, and four patients had local perineal wound complications. Two patients developed local recurrence after a median follow-up of 16 months. Conclusion The extended posterior perineal approach with gluteus maximus flap reconstruction in APR has a low risk of bowel perforation, CRM involvement and local perineal wound complications. The rate of local recurrence may be lower than with conventional APR.This publication has 26 references indexed in Scilit:
- Low Rectal Cancer: A Call for a Change of Approach in Abdominoperineal ResectionJournal of Clinical Oncology, 2005
- The Modern Abdominoperineal ExcisionAnnals of Surgery, 2005
- Primary Perineal Wound Closure After Preoperative Radiotherapy and Abdominoperineal Resection has a High Incidence of Wound FailureDiseases of the Colon & Rectum, 2005
- Risk Factors for Perineal Wound Complications Following Abdominoperineal ResectionDiseases of the Colon & Rectum, 2005
- Impact of a surgical training programme on rectal cancer outcomes in StockholmBritish Journal of Surgery, 2004
- Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery at a national levelBritish Journal of Surgery, 2004
- Oncological Outcomes After Total Mesorectal Excision for Cure for Cancer of the Lower Rectum: Anterior vs. Abdominoperineal ResectionDiseases of the Colon & Rectum, 2004
- Rectal CancerArchives of Surgery, 1998
- Abdominoperineal excision of the rectum—An endangered operationDiseases of the Colon & Rectum, 1997
- Local recurrence following total mesorectal excision for rectal cancerBritish Journal of Surgery, 1996