A meta-analysis on risk factors of postoperative perineal wound complications after abdominoperineal resection for rectal cancer / 中华胃肠外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the risk factors of postoperative perineal wound complications after abdominoperineal resection for rectal cancer.</p><p><b>METHODS</b>The databases of Medline, Embase, Web of Science, Ovid, Cochrane Library, CBM, CNKI, VIP and WANFANG were searched for the studies of abdominoperineal resection up to October 2016. The quality of the included studies was assessed by using "Cochrane collaboration's tool for assessing risk of bias" and "the Newcastle-Ottawa Scale". The meta-analyses were performed with Review Manager 4.3 software.</p><p><b>RESULTS</b>Eight randomized controlled trials and 33 non-randomized controlled trials with 15 287 patients were enrolled. Meta-analyses showed that neoadjuvant radiotherapy (OR=2.55, 95%CI 1.66 to 3.93, P<0.01) and obesity (OR=2.12, 95%CI 1.05 to 4.26, P=0.04) significantly increased the morbidity of perineal wound complication after abdominoperineal resection for rectal cancer; omentoplasty(OR=0.30, 95%CI 0.14 to 0.67, P=0.003), presacral space clysis (OR=0.11, 95%CI 0.01 to 0.94, P=0.04), abdominal drainage (OR=0.36, 95%CI 0.21 to 0.63, P<0.01), perineal skin drainage(OR=41.72, 95%CI 2.39 to 727.90, P=0.01) and local application of antibiotics (OR=0.17,95%CI 0.07 to 0.40, P<0.01) significantly decreased the morbidity of perineal wound complication; however, extralevator abdominoperineal excision (OR=0.88, 95%CI 0.57 to 1.35, P=0.56), laparoscopic procedure (OR=1.02, 95%CI 0.47 to 2.21, P=0.96), biologic mesh reconstruction (OR=1.81, 95%CI 0.95 to 3.46, P=0.07), myocutaneous flap reconstruction (OR=1.32, 95%CI 0.18 to 9.91, P=0.79) and negative pressure drainage(OR=0.69, 95%CI 0.35 to 1.34, P=0.27) had no influence on the healing of perineal wound.</p><p><b>CONCLUSIONS</b>Numerous factors can affect the occurrence of perineal wound complication after abdominoperineal resection for rectal cancer. Due to the limitations of enrolled studies, multicenter large scale and high-quality randomized controlled trials are required to validate the current results.</p>