Reconstruction of the perineum following extralevator abdominoperineal excision for carcinoma of the lower rectum: a systematic review

被引:88
作者
Foster, J. D. [1 ]
Pathak, S. [2 ]
Smart, N. J. [3 ]
Branagan, G. [4 ]
Longman, R. J. [3 ]
Thomas, M. G. [3 ]
Francis, N. [1 ]
机构
[1] Yeovil Dist Hosp, Yeovil, England
[2] Royal United Hosp, Bath BA1 3NG, Avon, England
[3] Univ Hosp Bristol, Bristol, Avon, England
[4] Salisbury Dist Hosp, Salisbury, Wilts, England
关键词
ELAPE; rectum; cancer; reconstruction; biologic; mesh; flap; TOTAL MESORECTAL EXCISION; PELVIC FLOOR; PREOPERATIVE RADIOTHERAPY; FLAP RECONSTRUCTION; RESECTION; CANCER; COMPLICATIONS; EXPERIENCE; SINGLE;
D O I
10.1111/j.1463-1318.2012.03169.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Aim An improvement in oncological outcome has been reported following an extralevator approach to abdominoperineal excision (ELAPE) for low rectal carcinoma. A larger perineal defect following ELAPE and the impact of neoadjuvant radiotherapy are sources of considerable morbidity for patients. We report an evidence-based systematic review of published data on the outcome of perineal reconstruction following ELAPE for low rectal carcinoma, comparing the use of tissue flap and biological mesh techniques. Method A literature search was performed of electronic databases including the Medline, Embase and Scopus databases (19952011). Studies describing outcomes relating to the perineum following ELAPE were included for review. Results Eleven small cohort studies reported the outcome relating to the perineum following ELAPE. Pooled-analysis of 255 combined patients undergoing flap repair and 85 undergoing biological mesh repair showed no significant difference in the rates of perineal wound complications or perineal hernia formation. Conclusion There is little information on the optimal technique of perineal wound closure following ELAPE. With the limited data available, there was no significant difference in complication rates between biological mesh and flap repair. There is a need for high-quality prospective trials to compare methods of reconstruction to determine the long-term results, quality of life and function.
引用
收藏
页码:1052 / 1059
页数:8
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