Risk factors for the perineal incision complications after abdominoperineal excision for rectal cancer / 中华胃肠外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the factors affecting perineal incision complications after abdominperineal excision(APE) for rectal cancer.</p><p><b>METHODS</b>This was a retrospective study of 167 patients with rectal cancer undergoing APE at Peking University People's Hospital between October 1998 and December 2013. Chi-square test and multivariate Logistic regression analysis were used to identify risk factors.</p><p><b>RESULTS</b>The overall rate of perineal incision complication was 24.6%(41/167) including 7 cases of incision infection, 10 cases of incision fat liquefaction, 21 cases of poor wound healing, 2 cases of incision fistula, 1 case of incision dehiscence. In univariate analysis, the risk factors associated with perineal incision complication were operating time≥280 minutes(P=0.005), blood loss≥350 ml(P=0.017) and the protective factors associated with perineal incision complication were the procedure of APE (P=0.048), intraperitoneal chemotherapy with 5-FU sustained release (P=0.014), lymph node metastasis (P=0.006), while gender, age, BMI, ASA score, other complications, distance from distal tumor to anal verge, preoperative radiochemotherapy, postoperative stay in ICU, total drainage volume 3 days before operation, tumor differentiation, and postoperative TNM staging were not associated with perineal incision complication(all P>0.05). Multivariate logistic regression analysis identified two independent risk factors operating time≥280 minutes(OR=5.217, 95% CI1.250 - 6.234, P=0.000), intraperitoneal chemotherapy with 5-FU sustained release(OR=3.284, 95% CI1.156 - 9.334, P=0.026).</p><p><b>CONCLUSIONS</b>Operating time≥280 minutes and intraperitoneal chemotherapy with 5-FU sustained release are independent risk factors for perineal incision complications after APE for rectal cancer. For patients receiving APE procedure, intraperitoneal chemotherapy with 5-FU sustained release should be used with caution, and the operative time should be reduced when possible.</p>