Extended pelvic resection for rectal and anal canal tumors
is a signiﬁcant risk factor for perineal wound infection: a retrospective
· Yuji Nishizawa
· Koji Ikeda
· Yuichiro Tsukada
· Takeshi Sasaki
· Masaaki Ito
Received: 19 January 2018 / Accepted: 21 May 2018
© Springer Nature Singapore Pte Ltd. 2018
Purpose Perineal wound infection (PWI) rates are high after abdominoperineal resection (APR) and total pelvic exenteration
(TPE). This study identiﬁed risk factors for PWI after surgery for anorectal tumors and examined the relationship between
the surgical excision volume with the PWI degree.
Methods A retrospective review involving 135 patients who underwent surgical excision of anorectal tumors was performed.
Superﬁcial PWI included cellulitis and superﬁcial dehiscence; deep PWI included major dehiscence, perineal abscess, and
presacral abscess. The adjacent organ resection type was classiﬁed according to the dead space size formed by surgical
Results Of the 135 patients, 119 underwent APR, and 16 underwent TPE. PWI occurred in 75 patients (superﬁcial PWI,
44; deep PWI, 31). Adjacent organ resection was an independent risk factor for PWI. The cases with adjacent organ resec-
tion were classiﬁed into small-defect APR, large-defect APR, and TPE. Large-defect APR and TPE cases had signiﬁcantly
higher rates of deep PWI than APR cases without adjacent organ resection.
Conclusions Adjacent organ resection involving the removal of one or more organs and that involving wide-range muscle
resection are strong risk factors for deep PWI.
Keywords Perineal wound infection · Abdominoperineal resection · Total pelvic exenteration · Adjacent organ resection
Abdominoperineal resection (APR) is performed for patients
with primary or recurrent low rectal and anal canal tumors.
In advanced cases, extensive aggressive surgery, such as
total pelvic exenteration (TPE), may be necessary for cura-
tive treatment. The perineal wound complication rates
associated with APR and TPE may be as high as 60% [1,
2]. These high complication rates are thought to be due to
the large dead space in the pelvis following APR and TPE,
closure under tension, and closure of a wound in an area
with a high bacterial count [3–5]. If primary healing of the
perineum does not occur, secondary wound healing may pro-
long the hospital stay and require surgical reintervention;
this often requires intensive wound care for several months
and carries a risk of persistent sinusitis development after
1 year [6, 7].
Preoperative radiotherapy and extensive resection are risk
factors for complications [8–10]. Extended APR includes
extralevator APR, which is widely considered a risk fac-
tor for perineal wound complications [10–12], and adja-
cent organ resection, on which there have been relatively
few studies . We were unable to ﬁnd information in the
literature regarding the relationship between the surgical
excision volume and the degree of perineal wound infec-
tion (PWI). Therefore, the primary aim of this study was to
identify risk factors for PWI after surgical excision of the
rectum and anal canal for tumor treatment. The secondary
aim was to examine the relationship of the surgical excision
volume with the degree of PWI.
* Yuji Nishizawa
* Masaaki Ito
Department of Colorectal Surgery, National Cancer
Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa,
Chiba 277-8577, Japan