Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Nov;30(11):1563-70.
doi: 10.1007/s00384-015-2328-1. Epub 2015 Aug 6.

Persistent perineal morbidity is common following abdominoperineal excision for rectal cancer

Dan Asplund  1 , Mattias Prytz  2   3 , David Bock  2 , Eva Haglind  2 , Eva Angenete  2
Affiliations
Observational Study

Persistent perineal morbidity is common following abdominoperineal excision for rectal cancer

Dan Asplund et al. Int J Colorectal Dis. 2015 Nov.

Abstract

Purpose: Short-term complications related to the perineal wound after abdominoperineal excision (APE) are a well-known problem. Perineal morbidity in the longer term is an almost unexplored area. The aim of this cross-sectional study was to investigate the prevalence of perineal symptoms 3 years after APE for rectal cancer, to identify potential risk factors and to explore the relationship between perineal morbidity and global quality of life.

Method: All patients who underwent APE in Sweden between 2007 and 2009 (n = 1373) were identified through the Swedish Colorectal Cancer Registry. Surviving patients were contacted 3 years after surgery and asked about participation. A total of 545 patients completed a detailed questionnaire. Clinical data was collected from the registry and surgical charts.

Results: Perineal symptoms occurred in 50 % of all patients 3 years after APE and more frequently in women (58 vs. 44 %; p = 0.001). Delayed healing of the perineal wound (>4 weeks) occurred in 25 % of all patients and more frequently after extralevator APE (ELAPE) than after conventional APE (32 vs. 11 %, p < 0.001). Delayed healing was associated with an increased risk of more severe perineal symptoms (relative risk (RR) 1.50, 95 % confidence interval (95 % CI) 1.09-2.05). Patients with more severe perineal symptoms (n = 129) had a significantly lower global quality of life as measured by EQ-5D visual analogue scale (VAS; median 75 vs. 83 points on the 100-point scale; p < 0.001).

Conclusion: Persistent perineal symptoms are common after APE and may have an impact on patients' quality of life. Delayed wound healing may be a risk factor for persistent symptoms. Further studies are needed to identify avoidable clinical factors for the development of persistent perineal morbidity. CLINICALTRIALS.

Gov identifier: NCT01296984.

Keywords: Abdominoperineal excision; Perineal morbidity; Quality of life; Rectal cancer.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Development of a study-specific questionnaire
Fig. 2
Fig. 2
Flowchart of patients
See this image and copyright information in PMC

References

    1. Angenete E, Correa-Marinez A, Heath J, et al. Ostomy function after abdominoperineal resection—a clinical and patient evaluation. Int J Colorectal Dis. 2012;27:1267–1274. doi: 10.1007/s00384-012-1463-1. - DOI - PubMed
    1. Asplund D, Haglind E, Angenete E. Outcome of extralevator abdominoperineal excision compared with standard surgery: results from a single centre. Colorectal Dis. 2012;14:1191–1196. doi: 10.1111/j.1463-1318.2012.02930.x. - DOI - PubMed
    1. Asplund D, Heath J, Gonzalez E, et al. Self-reported quality of life and functional outcome in patients with rectal cancer—QoLiRECT. Dan Med J. 2014;61:A4841. - PubMed
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72. doi: 10.1016/0168-8510(96)00822-6. - DOI - PubMed
    1. Greenland S. Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case–control studies. Am J Epidemiol. 2004;160:301–305. doi: 10.1093/aje/kwh221. - DOI - PubMed

Publication types

Associated data