Total perineal reconstruction after abdominoperineal excision for rectal cancer: long-term results of dynamic graciloplasty with Malone appendicostomy

Aim  This study aimed to assess long‐term function after total perineal reconstruction (TPR) with dynamic graciloplasty (DG) and systematic Malone appendicostomy (MA) adjunction after abdominoperineal excision (APR) for rectal cancer. Method  From 1999 to 2004, TPR using DG and MA was performed in 1...

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Bibliographic Details
Published in:Colorectal disease 2011-04, Vol.13 (4), p.406-413
Main Authors: Abbes Orabi, N., Vanwymersch, T., Paterson, H. M., Mauel, E., Jamart, J., Crispin, B., Kartheuser, A.
Format: Article
Language:English
Subjects:
abdominoperineal resection
Adenocarcinoma - psychology
Adenocarcinoma - surgery
Adult
dynamic graciloplasty
Enterostomy - adverse effects
Enterostomy - methods
Fecal Incontinence - etiology
Fecal Incontinence - surgery
Female
Humans
Male
Malone appendicostomy
Middle Aged
Perineum - surgery
Prospective Studies
Quality of Life
Reconstructive Surgical Procedures - adverse effects
Reconstructive Surgical Procedures - methods
Rectal cancer
Rectal Neoplasms - psychology
Rectal Neoplasms - surgery
Surveys and Questionnaires
total perineal reconstruction
Treatment Outcome
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Summary:Aim  This study aimed to assess long‐term function after total perineal reconstruction (TPR) with dynamic graciloplasty (DG) and systematic Malone appendicostomy (MA) adjunction after abdominoperineal excision (APR) for rectal cancer. Method  From 1999 to 2004, TPR using DG and MA was performed in 10 patients [seven women; median age 40 (range 28–55) years] after APR for rectal cancer (cT2 in one patient, cT3 in six patients and cT4 in three patients). We prospectively recorded early and late morbidity, mortality, oncological outcome, functional results (using the modified Working Party on Anal Sphincter Replacement ‘WPASR’ scoring system) and quality of life (QoL; using the European Organisation for Research and Treatment of Cancer ‘EORTC’ QLQ‐C30 and QLQ‐CR38 questionnaires). Results  There was no procedure‐related mortality. One patient required intra‐abdominal re‐operation. Nine patients required local and multiple revisions [there was one coloperineal anastomosis (CPA) stenosis, five CPA mucosal prolapse, three stenosis related to graciloplasty, two MA stenosis and one MA reflux]. After a median follow up of 78 months, there was no local recurrence and six patients were alive and disease‐free. Regarding the functional results, the median modified WPASR score, of 8, after a follow up of 78 months, was good. The overall QoL scores remained stable over time. Conclusion  In carefully selected patients who want to avoid definitive abdominal colostomy after APR for rectal cancer, reconstruction involving MA and DG after APR for low rectal cancer is followed by good long‐term function and QoL.
ISSN:1462-8910
1463-1318
DOI:10.1111/j.1463-1318.2009.02168.x