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News

Preoperative radiotherapy increases perineal infections

Short course preoperative radiotherapy increases perineal wound complications after abdominoperineal excision of the rectum, shows November's Colorectal Diseases.

News image

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Dr Chadwick and colleagues from England determined factors associated with perineal wound complications following abdominoperineal excision of the rectum for rectal adenocarcinoma.

The team also assessed the effects of perineal wound on time to healing.

The research team studied all cases of abdominoperineal excision of the rectum performed in our unit by 4 consultants over 7 years.

The researchers analyzed 7 out of 9 factors considered important in wound healing using logistic regression.

The team built a multivariate model to examine interactions.

Wound persistence was calculated using the Kaplan-Meier method.

Data was available for 94 of 96 patients.

The team reported that 41% of patients had 25 Gray, 3-portal, fractionated 5-day short course preoperative radiotherapy.

The researchers noted the various Dukes stages, and found that 34% were stage A, 26% were B, and 40% were C.

Perineal wound complications occurred in 47%
Colorectal Diseases

Perineal wound complications occurred in 47%, and 16% of these required returning to theatre.

The researchers observed local recurrences occurred in 15%.

The team found that neither patient gender, age, smoking status, nor preoperative albumin were associated with wound complications.

Wound complications were also not associated with haemoglobin levels, or T stage.

The odds of wound complications with short course preoperative radiotherapy was over 10 times than without preoperative radiotherapy.

The researchers noted that 74% of short course preoperative radiotherapy, and 96% of non- short course preoperative radiotherapy wounds had healed by 1 year.

Estimated failed wound healing rates at 30 and 90 days were 64%, and 48% in short course preoperative radiotherapy patients.

In non- short course preoperative radiotherapy, the team found that failed wound healing rates at 30 and 90 days were 23%, and 9%, respectively.

Dr Chadwick's team concludes, “Patients who have an abdominoperineal excision of the rectum are over 10 times more likely to have a perineal wound complication if they have short course preoperative radiotherapy than not.”

“Most of these will not have healed by 1 month, half by 3 months and over a quarter will still remain unhealed at 1 year.”

“This has important implications for patient management decisions.”

“Large prospective studies are needed to evaluate the effects of a selective policy for radiotherapy administered to patients requiring abdominoperineal excision of the rectum.”

Colorectal Dis 2006:8(9):756
03 November 2006

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