Información del artículo
Abstract
Despite the advances in the treatment of cancer of the rectum and the expansion of the multimodal therapeutic technique, abdominoperineal resection (APR) still needs to be performed as radical treatment in 20%–30% of cases.
APR of the rectum involves a significant morbidity, including intestinal obstruction and wound complications, with radiotherapy-induced enteritis being able to develop in 15% of cases subjected to post-operative radiotherapy. Furthermore, with the aim of improving local oncology results, an extended APR is recommended; a technique that requires a perineal reconstruction technique that allows a tension free closure in a previously radiated tissue and may prevent perineal hernias developing.
The objective of this article is to review pelvic and perineal repair methods after APR due to cancer, with special attention to the new prosthetic repair techniques.
Keywords:
Abdominoperineal resection
Rectal cancer
Pelvis
Pelvic floor
Perineum
Reconstruction
Resumen
A pesar de los avances en el tratamiento del cáncer de recto y la expansión del abordaje terapéutico multimodal, todavía es necesaria la realización de una amputación abdominoperineal (AAP) como tratamiento radical en el 20–30% de los casos.
La AAP del recto está gravada con una importante morbilidad, destacando la obstrucción intestinal y las complicaciones de la herida, pudiendo desarrollarse una enteritis rádica en el 15% de los casos sometidos a radioterapia postoperatoria. Además, con el fin de mejorar los resultados oncológicos a nivel local, se recomienda la realización de una AAP ampliada, técnica que precisa de un procedimiento de reconstrucción perineal que permita un cierre sin tensión en un tejido previamente radiado y prevenga el desarrollo de hernias perineales.
El objetivo de este trabajo es revisar los métodos de reparación pélvica y perineal tras la AAP por cáncer, con especial atención a las nuevas técnicas de reparación protésica.
Palabras clave:
Resección abdominoperineal
Cáncer de recto
Pelvis
Suelo pélvico
Periné
Reconstrucción
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References
[1.]
G. López-Abente, M. Pollán, N. Aragonés, B. Pérez Gómez, V. Hernández Barrera, V. Lope, et al.
Situación del cáncer en España: incidencia.
An Sist San Navar, 27 (2004), pp. 165-173
[2.]
E. Morris, P. Quirke, J.D. Thomas, L. Fairley, B. Cottier, D. Forman.
Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene?.
Gut, 57 (2008), pp. 1690-1697
[3.]
M. Pera, M. Pascual.
Quality standards in rectal cancer surgery.
Gastroenterol Hepatol, 28 (2005), pp. 417-425
[4.]
C.W. Pollard, S. Nivatvongs, A. Rojanasakul, D.M. Ilstrup.
Carcinoma of the rectum. Profiles of intraoperative and early postoperative complications.
Dis Colon Rectum, 37 (1998), pp. 866-874
[5.]
D.P. O’Brien, A. Senagore, J. Merlino, K. Brady, C. Delaney.
Predictors and outcome of readmission after laparoscopic intestinal surgery.
World J Surg, 31 (2007), pp. 2430-2435
[6.]
G. El Gazzaz, R.P. Kiran, I. Lavery.
Wound complications in rectal cancer patients undergoing primary closure of the perineal wound after abdominoperineal resection.
Dis Colon Rectum, 52 (2009), pp. 1962-1966
[7.]
B.E. Waddell, M.A. Rodriguez-Bigas, R.J. Lee, T.K. Weber, N.J. Petrelli.
Prevention of chronic radiation enteritis.
J Am Coll Surg, 189 (1999), pp. 611-624
[8.]
J.M. Regimbeau, Y. Panis, J.L. Gouzi, P.L. Fagniez.
Operative and long term results after surgery for chronic radiation enteritis.
Am J Surg, 182 (2001), pp. 237-242
[9.]
T. Holm, A. Ljung, T. Häggmark, G. Jurell, J. Lagergren.
Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer.
Br J Surg, 94 (2007), pp. 232-238
[10.]
N.P. West, P.J. Finan, C. Anderin, T. Lindholm, T. Holm, P. Quirke.
Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer.
J Clin Oncol, 21 (2008), pp. 3617-3622
[11.]
K.M. Bullard, J.L. Trudel, N.N. Baxter, D.A. Rothenberger.
Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure.
Dis Colon Rectum, 48 (2005), pp. 438-443
[12.]
E. Aboian, D.C. Winter, D.R. Metcalf, B.G. Wolff.
Perineal hernia after proctectomy: prevalence, risks, and management.
Dis Colon Rectum, 49 (2006), pp. 1564-1568
[13.]
V.S. Theis, R. Sripadam, V. Ramani, S. Lal.
Chronic radiation enteritis.
Clin Oncol, 22 (2010), pp. 70-83
[14.]
N. Druzijanić, Z. Perko, D. Srsen, Z. Pogorelić, D. Schwarz, J. Juricić.
Pelvic peritonization after laparoscopic abdominoperineal resection for low-rectal carcinoma treatment: surgical technique.
Hepatogastroenterology, 56 (2009), pp. 1028-1031
[15.]
H. Freund, L. Gunderson, R. Krause, J.E. Fischer.
Prevention of radiation enteritis after abdominoperineal resection and radiotherapy.
Surg Gynecol Obstet, 149 (1979), pp. 206-208
[16.]
J.S. Chen, C.R. ChangChien, J.Y. Wang, H.A. Fan.
Pelvic peritoneal reconstruction to prevent radiation enteritis in rectal carcinoma.
Dis Colon Rectum, 35 (1992), pp. 897-901
[17.]
C.V. Ruckley, A.N. Smith, T.W. Balfour.
Perineal closure by omental graft.
Surg Gynecol Obstet, 131 (1970), pp. 300-302
[18.]
C.P. Page, P.K. Carlton, D.W. Becker.
Closure of the pelvic and perineal wounds after removal of the rectum and anus.
Dis Colon Rectum, 23 (1980), pp. 2-9
[19.]
J.E. Russ, G.L. Smoron, J.D. Gagnon.
Omental transposition flap in colorectal carcinoma: adjunctive use in prevention and treatment of radiation complications.
Int J Radiat Oncol Biol Phys, 10 (1984), pp. 55-62
[20.]
J. Moreaux, A. Horiot, F. Barrat, J. Mabille.
Obliteration of the pelvic space with pedicled omentum after excision of the rectum for cancer.
Am J Surg, 148 (1984), pp. 640-644
[21.]
S.R. Smith, I. Swift, H. Gompertz, W.N. Baker.
Abdominoperineal and anterior resection of the rectum with retrocolic omentoplasty and no drainage.
Br J Surg, 75 (1988), pp. 1012-1015
[22.]
G.J. Poston, S.R. Smith, W.N. Baker.
Retrocolic pelvic omentoplasty in abdominoperineal excision of the rectum.
Ann R Coll Surg Engl, 73 (1991), pp. 229-232
[23.]
H. John, P. Buchmann.
Improved perineal wound healing with the omental pedicle graft after rectal excision.
Int J Colorectal Dis, 6 (1991), pp. 193-196
[24.]
M.L. Rice, A.M. Hay, R.H. Hurlow.
Omentoplasty in abdominoperineal resection of the rectum.
ANZ J Surg, 62 (1992), pp. 147-149
[25.]
J.M. Hay, A. Fingerhut, J.C. Paquet, Y. Flamant.
Management of the pelvic space with or without omentoplasty after abdominoperineal resection for carcinoma of the rectum: A prospective multicenter study. The French Association for Surgical Research.
Eur J Surg, 163 (1997), pp. 199-206
[26.]
E. De Broux, Y. Parc, F. Rondelli, N. Dehni, E. Tiret, R. Parc.
Sutured perineal omentoplasty after abdominoperineal resection for adenocarcinoma of the lower rectum.
Dis Colon Rectum, 48 (2005), pp. 476-481
[27.]
P.J. Nilsson.
Omentoplasty in abdominoperineal resection: a review of the literature using a systematic approach.
Dis Colon Rectum, 49 (2006), pp. 1354-1361
[28.]
P. Lechner, H. Cesnik.
Abdominopelvic omentopexy: preparatory procedure for radiotherapy in rectal cancer.
Dis Colon Rectum, 35 (1992), pp. 1157-1160
[29.]
H.J. Choi, H.S. Lee.
Effect of omental pedicle hammock in protection against radiation-induced enteropathy in patients with rectal cancer.
Dis Colon Rectum, 38 (1995), pp. 276-280
[30.]
J.J. Tuech, V. Chaudron, V. Thoma, J.C. Ollier, V. Tassetti, D. Duval, et al.
Prevention of radiation enteritis by intrapelvic breast prosthesis.
Eur J Surg Oncol, 30 (2004), pp. 900-904
[31.]
M. Dürig, U. Steenblock, M. Heberer, F. Harder.
Prevention of radiation injuries to the small intestine.
Surg Gynecol Obstet, 159 (1984), pp. 162-163
[32.]
J.P. Hoffman, E.R. Sigurdson, B.L. Eisenberg.
Use of saline-filled tissue expanders to protect the small bowel from radiation.
Oncology, 12 (1998), pp. 51-54
[33.]
K. Angster, S.M. Shridharani, A.N. Rad, N. Ahuja, G.D. Rosson.
Intraabdominal tissue expanders to prevent radiation enteritis: preliminary report.
Plast Reconstr Surg, 125 (2010), pp. 177-179
[34.]
J.P. Hoffman, R. Lanciano, N.Z. Carp, M.A. Merrick, N.G. Rosenblum, W.M. Hogan, et al.
Morbidity after intraperitoneal insertion of saline-filled tissue expanders for small bowel exclusion from radiotherapy treatment fields: a prospective four year experience with 34 patients.
Am Surg, 60 (1994), pp. 473-482
[35.]
J.T. Vetto, S.C. Culp, T.B. Smythe, A.E. Chang, W.F. Sindelar, P.H. Sugarbaker, et al.
Iliac arterial-enteric fistulas occurring after pelvic irradiation.
Surgery, 101 (1987), pp. 643-647
[36.]
D.F. Devereux, J.J. Chandler, T. Eisenstat, L. Zinkin.
Efficacy of an absorbable mesh in keeping the small bowel out of the human pelvis following surgery.
Dis Colon Rectum, 31 (1988), pp. 17-21
[37.]
S.F. Sener, J.P. Imperato, M.D. Blum, J.M. Ignatoff, T.G. Soper, D.P. Winchester, et al.
Technique and complications of reconstruction of the pelvic floor with polyglactin mesh.
Surg Gynecol Obstet, 168 (1989), pp. 475-480
[38.]
K.S. Dasmahapatra, A.P. Swaminathan.
The use of a biodegradable mesh to prevent radiation-associated small-bowel injury.
Arch Surg, 126 (1991), pp. 366-369
[39.]
J.F. Rodier, J.C. Janser, D. Rodier, J. Dauplat, P. Kauffmann, G. Le Bouedec, et al.
Pevention of radiation enteritis by an absorbable polyglycolic acid mesh sling. A 60-case multicentric study.
Cancer, 68 (1991), pp. 2545-2549
[40.]
A. Beitler, M.A. Rodriguez-Bigas, T.K. Weber, R.J. Lee, R. Cuenca, N.J. Petrelli.
Complications of absorbable pelvic mesh slings following surgery for rectal carcinoma.
Dis Colon Rectum, 40 (1997), pp. 1336-1341
[41.]
M. Kusunoki, H. Yanagi, Y. Shoji, M. Noda, H. Ikeuchi, T. Yamamura.
Reconstruction of the pelvic floor using absorbable mesh with a bioresorbable membrane (Seprafilm) after abdominoperineal rectal excision.
J Surg Oncol, 70 (1999), pp. 261-262
[42.]
B.E. Waddell, R.J. Lee, M.A. Rodriguez-Bigas, T.K. Weber, N.J. Petrelli.
Absorbable mesh sling prevents radiation-induced bowel injury during “sandwich” chemoradiation for rectal cancer.
Arch Surg, 135 (2000), pp. 1212-1217
[43.]
J. Cui, J.P. Ma, J. Xiang, Y.X. Luo, S.R. Cai, Y.H. Huang, et al.
Prospective study of reconstructing pelvic floor with GORETEX Dual Mesh in abdominoperineal resection.
Chin Med J, 122 (2009), pp. 2138-2141
[44.]
W.L. Baird, T.R. Hester, F. Nahai, J. Bostwick.
Management of perineal wounds following abdominoperineal resection with inferior gluteal flaps.
Arch Surg, 125 (1990), pp. 1486-1489
[45.]
D. Shibata, W. Hyland, P. Busse, H.K. Kim, S.M. Sentovich, G. Steele, et al.
Immediate reconstruction of the perineal wound with gracilis muscle flaps following abdominoperineal resection and intraoperative radiation therapy for recurrent carcinoma of the rectum.
Ann Surg Oncol, 6 (1999), pp. 33-37
[46.]
C.E. Butler, M.A. Rodriguez-Bigas.
Pelvic reconstruction after abdominoperineal resection: is it worthwhile?.
Ann Surg Oncol, 12 (2005), pp. 91-94
[47.]
D.B. Chessin, J. Hartley, A.M. Cohen, M. Mazumdar, P. Cordeiro, J. Disa, et al.
Rectus flap reconstruction decreases perineal wound complications after pelvic chemoradiation and surgery: a cohort study.
Ann Surg Oncol, 12 (2005), pp. 91-94
[48.]
J.H. Lefevre, Y. Parc, S. Kernéis, C. Shields, E. Touboul, M. Chaouat, et al.
Abdomino-perineal resection for anal cancer: impact of a vertical rectus abdominis myocutaneus flap on survival, recurrence, morbidity, and wound healing.
Ann Surg, 250 (2009), pp. 707-711
[49.]
P.J. Nisar, H.J. Scott.
Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision.
Colorectal Dis, 11 (2009), pp. 806-816
[50.]
R.A. Nelson, C.E. Butler.
Surgical outcomes of VRAM versus thigh flaps for immediate reconstruction of pelvic and perineal cancer resection defects.
Plast Reconstr Surg, 123 (2009), pp. 175-183
[51.]
M.A. Boccola, W.M. Rozen, E.W. Ek, B.M. Teh, M. Croxford, D. Grinsell.
Inferior gluteal artery myocutaneous island transposition flap reconstruction of irradiated perineal defects.
J Plast Reconstr Aesthet Surg, 63 (2010), pp. 1169-1175
[52.]
C.L. Boereboom, N.F. Watson, R. Sivakumar, N.G. Hurst, W.J. Speake.
Biological tissue graft for pelvic floor reconstruction after cylindrical abdominoperineal excision of the rectum and anal canal.
Tech Coloproctol, 13 (2009), pp. 257-258
[53.]
P. Wille-Jørgensen, B. Pilsgaard, P. Møller.
Reconstruction of the pelvic floor with a biological mesh after abdominoperineal excision for rectal cancer.
Int J Colorectal Dis, 24 (2009), pp. 323-325
[54.]
J.G. Han, Z.J. Wang, Z.G. Gao, H.M. Xu, Z.H. Yang, M.L. Jin.
Pelvic floor reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection.
Dis Colon Rectum, 53 (2010), pp. 219-223
[55.]
R. Candage, K. Jones, F.A. Luchette, J.M. Sinacore, D. Vandevender, R.L. Reed.
Use of human acellular dermal matrix for hernia repair: friend or foe?.
Surgery, 144 (2008), pp. 703-709
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