Perineal Healing and Survival After Anal Cancer Salvage Surgery: 10-Year Experience with Primary Perineal Reconstruction Using the Vertical Rectus Abdominis Myocutaneous (VRAM) Flap |
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Authors: | K G Sunesen S Buntzen T Tei J C Lindegaard M Nørgaard S Laurberg |
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Institution: | (1) Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark;(2) Department of Clinical Epidemiology, Aarhus University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark;(3) Department of Plastic Surgery Z, Aarhus University Hospital, Aarhus, Denmark;(4) Department of Oncology D, Aarhus University Hospital, Aarhus, Denmark |
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Abstract: | Salvage surgery of recurrent or persistent anal cancer following radiotherapy is often followed by perineal wound complications.
We examined survival and perineal wound complications in anal cancer salvage surgery during a 10-year period with primary
perineal reconstruction predominantly performed using vertical rectus abdominis myocutaneous (VRAM) flap. Between 1997 and
2006, 49 patients underwent anal cancer salvage surgery. Of these, 48 had primary reconstruction with VRAM. Overall survival
was computed by the Kaplan–Meier method and mortality rate ratios (MRRs) by Cox regression. One patient (2%) died within 30 days
postoperatively. Postoperative complications necessitated reoperation in eight (16%) patients. We found no major perineal
wound infections. Major perineal wound breakdown occurred in the only patient in whom VRAM was not used. Five-year survival
was 61% 95% confidence interval (CI) 43–75%]. Free resection margins (R0) were obtained in 78% of patients, with 5-year survival
of 75% (95% CI 53–87%). Involved margins, microscopically only (R1) or macroscopically (R2), strongly predicted an adverse
outcome age-adjusted 2-year MRRs (95% CI) R1 vs. R0 = 4.1 (0.7–23.6), R2 vs. R0 = 10.9 (2.2–54.2)]. We conclude that anal
cancer salvage surgery can yield long-time survival but obtaining free margins is critical. A low rate of perineal complications
is achievable by primary perineal reconstruction using VRAM flap. |
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