Nonhealing perineal wound is an unpleasant complication of surgical excision of the rectum and anus.
Dr Dmitri Artioukh and colleagues from England evaluated the risk factors for impaired perineal wound healing after abdominoperineal resection of rectum for adenocarcinoma.
Impaired perineal wound is increasing with the increasing use of neo-adjuvant chemoradiation.
The research team evaluated 38 consecutive patients, of which 29 were men, and 9 were women with a median age of 66 years.
The patients underwent surgical excision of the rectum and anus for adenocarcinoma from 1999 to 2004.
|7 factors contributed to 96% of impaired healing|
The team reported that 37 patients underwent abdominoperineal resection of the rectum.
The remaining patient developed carcinoma in the background of chronic ulcerative colitis, and underwent panproctocolectomy.
The researchers evaluated associations between the failure of the perineal wound to heal and a number of patient, tumor and treatment-related variables.
The research team used the Pearson chi-square test or Fisher's exact test, as appropriate.
Multivariate statistical technique of principal component analysis was also used to identify risk factors and their relative contribution to impaired healing.
The team observed impaired healing of the perineal wound in 26% of patients.
The researchers found that in 11% of patients, the wound remained nonhealed in 1 year after surgery.
Preoperative radiotherapy, and delayed primary closure of the wound was associated with impaired wound healing.
The team noted that alcohol consumption in excess of 28 units/week was also significantly associated with impaired wound healing.
The researchers used principal component analysis to identify the 7 factors that cumulatively contributed to 96% of impaired healing.
These factors include distant metastases, preoperative radiotherapy, and T-stage of the tumor.
The team identified smoking, perioperative blood transfusion, and preoperative chemotherapy as contributing to impaired healing.
In addition, the researchers found that development of side effects of preoperative chemoradiation impairs healing.
Dr Artioukh's team comments, “Patients who undergo abdominoperineal resection of rectum are prone to impaired healing of the perineal wound if radiotherapy is used to treat malignancy prior to surgery and wound closure is delayed.”
“We found that the wound may not heal in patients with distant metastases, and excessive alcohol consumption, and present or past smokers.
“In addition, the wound my not heal in those who suffer adverse effects of preoperative chemoradiation and require blood transfusion.”