. 2018 Mar;25(3):729-736.

doi: 10.1245/s10434-017-6273-9. Epub 2017 Dec 12.

Snapshot Study on the Value of Omentoplasty in Abdominoperineal Resection with Primary Perineal Closure for Rectal Cancer

Robin D Blok^{1

2}, Gijsbert D Musters¹, Wernard A A Borstlap¹, Christianne J Buskens¹, Wilhelmus A Bemelman¹, Pieter J Tanis³; Collaborative Dutch Snapshot Research Group

Collaborators, Affiliations

Collaborators

Collaborative Dutch Snapshot Research Group:
A Aalbers, Y Acherman, G D Algie, B Alting von Geusau, F Amelung, T S Aukema, I S Bakker, S A Bartels, S Basha, A J N M Bastiaansen, E Belgers, W Bleeker, J Blok, R J I Bosker, J W Bosmans, M C Boute, N D Bouvy, H Bouwman, A Brandt-Kerkhof, D J Brinkman, S Bruin, E R J Bruns, J P M Burbach, J W A Burger, S Clermonts, P P L O Coene, C Compaan, E C J Consten, T Darbyshire, S M L de Mik, E J R de Graaf, I de Groot, R J L de Vos Tot Nederveen Cappel, J H W de Wilt, J van der Wolde, F C den Boer, J W T Dekker, A Demirkiran, M Derkx-Hendriksen, F R Dijkstra, P van Duijvendijk, M S Dunker, Q E Eijsbouts, H Fabry, F Ferenschild, J W Foppen, E J B Furnée, M F Gerhards, P Gerven, J A H Gooszen, J A Govaert, W M U van Grevenstein, R Haen, J J Harlaar, E Harst, K Havenga, J Heemskerk, J F Heeren, B Heijnen, P Heres, C Hoff, W Hogendoorn, P Hoogland, A Huijbers, P Janssen, A C Jongen, F H Jonker, E G Karthaus, A Keijzer, J M A Ketel, J Klaase, F W H Kloppenberg, M E Kool, R Kortekaas, P M Kruyt, J T Kuiper, B Lamme, J F Lange, T Lettinga, D J Lips, F Logeman, M F Lutke Holzik, E Madsen, A Mamound, C C Marres, I Masselink, M Meerdink, A G Menon, J S Mieog, D Mierlo, G D Musters, P A Neijenhuis, J Nonner, M Oostdijk, S J Oosterling, P M P Paul, K C M J C Peeters, I T A Pereboom, F Polat, P Poortman, M Raber, B M M Reiber, R J Renger, C C van Rossem, H J Rutten, A Rutten, R Schaapman, M Scheer, L Schoonderwoerd, N Schouten, A M Schreuder, W H Schreurs, G A Simkens, G D Slooter, H C E Sluijmer, N Smakman, R Smeenk, H S Snijders, D J A Sonneveld, B Spaansen, E J Spillenaar Bilgen, E Steller, W H Steup, C Steur, E Stortelder, J Straatman, M Stuijvenberg, H A Swank, C Sietses, H A Ten Berge, H G Ten Hoeve, W W Ter Riele, I M Thorensen, B Tip-Pluijm, B R Toorenvliet, L Tseng, J B Tuynman, J van Bastelaar, S C van Beek, A W H van de Ven, M A J van de Weijer, C van den Berg, I van den Bosch, J D W van der Bilt, S J van der Hagen, R van der Hul, G van der Schelling, A van der Spek, N van der Wielen, E van Duyn, C van Eekelen, J A Van Essen, K Van Gangelt, A A W Van Geloven, C Van Kessel, Y T van Loon, A van Rijswijk, S J van Rooijen, T van Sprundel, L van Steensel, W F van Tets, H L van Westreenen, C J van de Velde, S Veltkamp, T Verhaak, P M Verheijen, L Versluis-Ossenwaarde, S Vijfhuize, W J Vles, S Voeten, F J Vogelaar, W W Vrijland, E Westerduin, M E Westerterp, M Wetzel, M Wevers, B Wiering, A C Witjes, M W Wouters, S T K Yauw, E C Zeestraten, D D Zimmerman, T Zwieten

Affiliations

¹ Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
² Centre for Experimental and Molecular Medicine, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. P.J.Tanis@amc.nl.

PMID: 29235007
PMCID: PMC5814519
DOI: 10.1245/s10434-017-6273-9

Snapshot Study on the Value of Omentoplasty in Abdominoperineal Resection with Primary Perineal Closure for Rectal Cancer

Robin D Blok et al. Ann Surg Oncol. 2018 Mar.

. 2018 Mar;25(3):729-736.

doi: 10.1245/s10434-017-6273-9. Epub 2017 Dec 12.

Authors

Robin D Blok^{1

2}, Gijsbert D Musters¹, Wernard A A Borstlap¹, Christianne J Buskens¹, Wilhelmus A Bemelman¹, Pieter J Tanis³; Collaborative Dutch Snapshot Research Group

Collaborators

Collaborative Dutch Snapshot Research Group:
A Aalbers, Y Acherman, G D Algie, B Alting von Geusau, F Amelung, T S Aukema, I S Bakker, S A Bartels, S Basha, A J N M Bastiaansen, E Belgers, W Bleeker, J Blok, R J I Bosker, J W Bosmans, M C Boute, N D Bouvy, H Bouwman, A Brandt-Kerkhof, D J Brinkman, S Bruin, E R J Bruns, J P M Burbach, J W A Burger, S Clermonts, P P L O Coene, C Compaan, E C J Consten, T Darbyshire, S M L de Mik, E J R de Graaf, I de Groot, R J L de Vos Tot Nederveen Cappel, J H W de Wilt, J van der Wolde, F C den Boer, J W T Dekker, A Demirkiran, M Derkx-Hendriksen, F R Dijkstra, P van Duijvendijk, M S Dunker, Q E Eijsbouts, H Fabry, F Ferenschild, J W Foppen, E J B Furnée, M F Gerhards, P Gerven, J A H Gooszen, J A Govaert, W M U van Grevenstein, R Haen, J J Harlaar, E Harst, K Havenga, J Heemskerk, J F Heeren, B Heijnen, P Heres, C Hoff, W Hogendoorn, P Hoogland, A Huijbers, P Janssen, A C Jongen, F H Jonker, E G Karthaus, A Keijzer, J M A Ketel, J Klaase, F W H Kloppenberg, M E Kool, R Kortekaas, P M Kruyt, J T Kuiper, B Lamme, J F Lange, T Lettinga, D J Lips, F Logeman, M F Lutke Holzik, E Madsen, A Mamound, C C Marres, I Masselink, M Meerdink, A G Menon, J S Mieog, D Mierlo, G D Musters, P A Neijenhuis, J Nonner, M Oostdijk, S J Oosterling, P M P Paul, K C M J C Peeters, I T A Pereboom, F Polat, P Poortman, M Raber, B M M Reiber, R J Renger, C C van Rossem, H J Rutten, A Rutten, R Schaapman, M Scheer, L Schoonderwoerd, N Schouten, A M Schreuder, W H Schreurs, G A Simkens, G D Slooter, H C E Sluijmer, N Smakman, R Smeenk, H S Snijders, D J A Sonneveld, B Spaansen, E J Spillenaar Bilgen, E Steller, W H Steup, C Steur, E Stortelder, J Straatman, M Stuijvenberg, H A Swank, C Sietses, H A Ten Berge, H G Ten Hoeve, W W Ter Riele, I M Thorensen, B Tip-Pluijm, B R Toorenvliet, L Tseng, J B Tuynman, J van Bastelaar, S C van Beek, A W H van de Ven, M A J van de Weijer, C van den Berg, I van den Bosch, J D W van der Bilt, S J van der Hagen, R van der Hul, G van der Schelling, A van der Spek, N van der Wielen, E van Duyn, C van Eekelen, J A Van Essen, K Van Gangelt, A A W Van Geloven, C Van Kessel, Y T van Loon, A van Rijswijk, S J van Rooijen, T van Sprundel, L van Steensel, W F van Tets, H L van Westreenen, C J van de Velde, S Veltkamp, T Verhaak, P M Verheijen, L Versluis-Ossenwaarde, S Vijfhuize, W J Vles, S Voeten, F J Vogelaar, W W Vrijland, E Westerduin, M E Westerterp, M Wetzel, M Wevers, B Wiering, A C Witjes, M W Wouters, S T K Yauw, E C Zeestraten, D D Zimmerman, T Zwieten

Affiliations

¹ Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
² Centre for Experimental and Molecular Medicine, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. P.J.Tanis@amc.nl.

PMID: 29235007
PMCID: PMC5814519
DOI: 10.1245/s10434-017-6273-9

Abstract

Background: Perineal wound complications are often encountered following abdominoperineal resection (APR). Filling of the pelvic space by omentoplasty (OP) might prevent these complications, but there is scant evidence to support its routine application.

Objective: The aim of this study was to evaluate the impact of OP on perineal wound complications.

Methods: All patients undergoing APR with primary perineal closure (PPC) for non-locally advanced rectal cancer in 71 Dutch centers in 2011 were selected from a cross-sectional snapshot study. Outcomes were compared between PPC with or without OP, which was based on variability in practice among surgeons.

Results: Of 639 patients who underwent APR for rectal cancer, 477 had a non-locally advanced tumor and PPC was performed. Of those, 172 (36%) underwent OP. Patients with OP statistically more often underwent an extralevator approach (32% vs. 14%). Median follow-up was 41 months (interquartile range 22-47). There were no significant differences with or without OP in terms of non-healing of the perineal wound at 30 days (47% vs. 48%), non-healing at the end of follow-up (9% vs. 5%), pelvic abscess (12% vs. 13%) or re-intervention for ileus (5% vs. 3%). Perineal hernia developed significantly more often after OP (13% vs. 7%), also by multivariable analysis (odds ratio 2.61, 95% confidence interval 1.271-5.364; p = 0.009).

Conclusions: In contrast to previous assumptions, OP after APR with PPC appeared not to improve perineal wound healing and seemed to increase the occurrence of perineal hernia. These findings question the routine use of OP for primary filling of the pelvic space.

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Figures

**Fig. 1**
Perineal wound healing over time with and without omentoplasty. *APR* abdominoperineal resection, FU follow-up

**Fig. 2**
Kaplan–Meier curve for developing a perineal hernia over time

**Fig. 3**
Two male patients after abdominoperineal resection with primary perineal closure for rectal cancer. a Computed tomography image, sagittal plane, showing descent of a small bowel loop with restricted mesenteric length. b Magnetic resonance image, sagittal plane, showing a large perineal hernia in which the hernia sac is filled with fully mobilized bulky omentum

See this image and copyright information in PMC

Comment in

Value of Omentoplasty in Abdominoperineal Resection with Primary Perineal Closure for Rectal Cancer.
Sandhu L, Chang GJ. Sandhu L, et al. Ann Surg Oncol. 2018 Dec;25(13):4049-4050. doi: 10.1245/s10434-018-6489-3. Epub 2018 Apr 26. Ann Surg Oncol. 2018. PMID: 29700670 No abstract available.
ASO Author Reflections: Omentoplasty to Improve Perineal Wound Healing After Abdominoperineal Resection.
Blok RD, Tanis PJ. Blok RD, et al. Ann Surg Oncol. 2018 Dec;25(Suppl 3):836-837. doi: 10.1245/s10434-018-6799-5. Epub 2018 Oct 16. Ann Surg Oncol. 2018. PMID: 30327970 Free PMC article. No abstract available.
Snapshot Study on the Value of Omentoplasty in Abdominoperineal Resection with Primary Perineal Closure for Rectal Cancer.
Wijsmuller AR, Hemmer PHJ. Wijsmuller AR, et al. Ann Surg Oncol. 2021 Dec;28(Suppl 3):801-802. doi: 10.1245/s10434-021-10474-4. Epub 2021 Aug 6. Ann Surg Oncol. 2021. PMID: 34363116 No abstract available.

References

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1. Bullard KM, Trudel JL, Baxter NN, Rothenberger DA. Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum. 2005;48(3):438–43. doi: 10.1007/s10350-004-0827-1. - DOI - PubMed
1. Howell AM, Jarral OA, Faiz O, Ziprin P, Darzi A, Zacharakis E. How should perineal wounds be closed following abdominoperineal resection in patients post radiotherapy–primary closure or flap repair? best evidence topic (BET) Int J Surg. 2013;11(7):514–17. doi: 10.1016/j.ijsu.2013.05.004. - DOI - PubMed
1. Nilsson PJ. Omentoplasty in abdominoperineal resection: a review of the literature using a systematic approach. Dis Colon Rectum. 2006;49(9):1354–61. doi: 10.1007/s10350-006-0643-x. - DOI - PubMed
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Snapshot Study on the Value of Omentoplasty in Abdominoperineal Resection with Primary Perineal Closure for Rectal Cancer

Collaborators

Affiliations

Snapshot Study on the Value of Omentoplasty in Abdominoperineal Resection with Primary Perineal Closure for Rectal Cancer

Authors

Collaborators

Affiliations

Abstract

Figures

Comment in

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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Medical

Miscellaneous