Материал и методы

oncotomsk

Сибирский онкологический журнал

Siberian journal of oncology

1814-48612312-3168

Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences

10.21294/1814-4861-2020-19-2-125-131

oncotomsk-1408

Research Article

ОБЗОРЫ

REVIEWS

Пластика тазового дна после экстралеваторной брюшнопромежностной экстирпации прямой кишки: обзор литературы

Pelvic floor reconstruction after extralevator abdominoperineal excision of the rectum: a literature review

https://orcid.org/0000-0001-7598-9341

Беляев

В. С.

Belyaev

V. S.

Беляев Владимир Сергеевич - врач-онколог отделения онкоколопроктологической хирургии, SPIN-код: 5219-3329.

Красноярск, 660133, ул. 1-я Смоленская, 16

Vladimir S. Belyaev - MD, Oncologist, Colorectal Cancer Surgery Department.

16, First Smolenskaya st., 660133, Krasnoyarsk

al.onka@yandex.ru

https://orcid.org/0000-0003-0075-215X

Дыхно

Ю. А.

Dykhno

Y. A.

Дыхно Юрий Александрович - доктор медицинских наук, профессор кафедры онкологии и лучевой терапии с курсом ПО, SPIN-код: 2505-2322. Researcher ID (WOS): 0-8028-2015.

Красноярск, 660022, ул. Партизана Железняка, 1

Yury A. Dykhno - MD, Professor, Department of Oncology and Radiation Therapy, Researcher ID (WOS): 0-8028-2015.

1, Partizana Zheleznyaka st., 660022, Krasnoyarsk

https://orcid.org/0000-0002-8586-3141

Несытых

А. А.

Nesytyh

A. A.

Несытых Анатолий Анатольевич - заведующий отделением онкоколопроктологической хирургии, SPIN-код: 7841-9806.

Красноярск, 660133, ул. 1-я Смоленская, 16

Anatoly A. Nesytykh - MD, Head of Colorectal Cancer Surgery Department.

16, First Smolenskaya st., 660133, Krasnoyarsk

КГБУЗ Красноярский краевой клинический онкологический диспансер им. А.И. КрыжановскогоРоссияA.I. Kryzhanovsky Krasnoyarsk Regional Clinical Oncologic DispensaryRussian Federation

ФГБОУ ВО «Красноярский государственный медицинский университет им. проф. В.Ф. Войно-Ясенецкого» Минздрава РоссииРоссияV.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia,Russian Federation

2020

30042020

192125131

2020

Беляев В.С., Дыхно Ю.А., Несытых А.А.

Belyaev V.S., Dykhno Y.A., Nesytyh A.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.siboncoj.ru/jour/article/view/1408

Цель исследования - обобщение имеющихся данных о различных вариантах пластики тазового дна после экстралеваторной брюшно-промежностной экстирпации прямой кишки по поводу рака, об их модификациях, существующих на сегодняшний день, а также их преимуществах и недостатках.

Материал и методы

Материал и методы. В обзор включены данные рандомизированных клинических исследований, сравнивающих результаты различных методик пластики тазового дна, найденные в библиотеках Medline, Embase и Cochrane, опубликованные за последние 20 лет.

Результаты

Результаты. На сегодняшний день существуют различные варианты пластики промежности после «цилиндрической» брюшно-промежностной экстирпации прямой кишки. Существующие методы направлены на устранение данных осложнений, но их результаты пока неудовлетворительны. Простое закрытие дефекта - экономичный способ закрытия раны, но с довольно частым развитием осложнений со стороны промежностной раны и формированием промежностной грыжи. Различные варианты мио- и аллопластики хотя и имеют ряд преимуществ, но более трудоемки и затратны.

Заключение

Заключение. На сегодняшний день имеется немного рандомизированных исследований, посвященных проблеме закрытия дефекта промежности после экстралеваторной брюшно-промежностной экстирпации прямой кишки, их противоречивые и неоднозначные данные требуют дальнейших исследований в этой области.

The purpose of the study was to analyze studies reporting pelvic floor reconstruction after extralevator abdominoperineal excision for rectal cancer, reconstruction options, including advantages and disadvantages.

Material and Methods

Material and Methods. A literature search was performed using the Medline, Embase and Cochrane Library databases. Randomized clinical studies reporting the pelvic floor reconstruction after extralevator abdominoperineal excision of the rectum were evaluated.

Results

Results. Although many surgical options are available for the management of perineal wounds after cylindrical abdominoperineal extirpation of the rectum, treatment remains challenging. Primary perineal defect closure is a simple and economical way to close a wound; however it has a high rate of perineal wound complications with occurrence of perineal hernia. Although various options of myo- and alloplastic reconstruction have several advantages, they are more labor-and cost-intensive.

Conclusion

Conclusion. There is a lack of randomized trials reporting the closure of the perineal defect after extralevator abdominoperineal extirpation of the rectum. There remains no consensus on which management strategy is superior; therefore, further studies are needed.

рак прямой кишкиэкстралеваторная экстирпация прямой кишкипластика тазового дна

colorectal cancerextralevator abdominoperineal excisionpelvic floor reconstruction

References1

Miles W.E. A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. The Lancet. 1908; 2: 1812-1815.

HealdR.J., Moran B.J., Ryall R.D.H., Sexton R., MacFarlane J.K. Rectal Cancer The Basingstoke Experience of Total Mesorectal Excision, 1978-1997. Arch. Surg. 1998; 133: 894-899. doi: 10.1001/archsurg.133.8.894.

Birbeck K.F., Macklin C.P., Tiffin NJ., Parsons W., Dixon M.F., Mapstone N.P., Abbott C.R., Scott N., Finan P.J., Johnston D., Quirke P. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002 Apr; 235(4): 449-57. doi: 10.1097/00000658-200204000-00001.

Mauvais F., Sabbagh C., Brehant O., ViartL., Benhaim T., FuksD., Sinna R., Regimbeau J.M. The current abdominoperineal resection: oncological problems and surgical modifications for low rectal cancer. J Visc Surg. 2011 Apr; 148(2): e85-93. doi: 10.1016/j.jviscsurg.2011.03.001.

Radcliffe A. Can the results of anorectal (abdominoperineal) resection be improved: are circumferential resection margins too often positive? Colorectal Dis. 2006 Mar; 8(3): 160-7. doi: 10.1111/j.1463-1318.2005.00913.x.

Holm T., Ljung A., Haggmark T., Jurell G., Lagergren J. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg. 2007; 94(2): 232-8. doi: 10.1002/bjs.5489.

West N.P., Anderin C., Smith KJ., Holm T., Quirke P.; European Extralevator Abdominoperineal Excision Study Group. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg. 2010 Apr; 97(4): 588-99. doi: 10.1002/bjs.6916.

Han J.G., Wang Z.J., Wei G.H., Gao Z.G., Yang Y., Zhao B.C. Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer. Am J Surg. 2012 Sep; 204(3): 274-82. doi: 10.1016/j.amjsurg.2012.05.001.

JensenK.K., RashidL., PilsgaardB., MollerP, Witte-JorgensenP. Pelvic floor reconstruction with a biological mesh after extralevator abdominoperineal excision leads to few perineal hernias and acceptable wound complication rates with minor movement limitations: single-centre experience including clinical examination and interview. Colorectal Dis. 2014; 16(3): 192-7. doi: 10.1111/codi.12492.

Jiang H.Y., Zhou Y.B., Zhang D.F. Meta-analysis of extralevator abdominoperineal excision and conventional abdominoperineal excision for low rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 2013; 16 (7): 622-7.

Stelzner S., Hellmich G., Schubert C., Puffer E., Haroske G., Witzigmann H. Short-term outcome of extralevator abdominoperineal excision for rectal cancer. Int J Colorectal Dis. 2011 Jul; 26(7): 919-25. doi: 10.1007/s00384-011-1157-0.

Welsch T., Mategakis V, Contin P., Kulu Y., M. W., Ulrich A. Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound complications. Int J Colorectal Dis. 2013 Apr; 28(4): 503-10. doi: 10.1007/s00384-012-1611-7.

Brizendine J.B., LeFaivre J.F., YostM.J., Fann S.A. Reconstruction of parasacral hernia with acellular human dermis graft. Hernia. 2006 Aug; 10(4): 360-3.

Musters G.D., Lapid O., Stoker J., Musters B.F., Bemelman W.A., Tanis P.J. Is there a place for a biological mesh in perineal hernia repair? Hernia. 2006 Oct; 20(5): 747-54. doi: 10.1007/s10029-016-1504-8.

Xu H.R., Xu Z.F., Li Z.J. Research progression of extralevator abdominoperineal excision. Zhonghua Wei Chang Wai Ke Za Zhi. 2013 Jul; 16(7): 698-700.

Irvin T.T., Goligher J.C. A controlled clinical trial of three different methods of perineal wound management following excision of the rectum. Br J Surg. 1975 Apr; 62(4): 287-91.

Bebenek M. Abdominosacral amputation of the rectum for low rectal cancers: ten years of experience. Ann Surg Oncol. 2009 Aug; 16(8): 2211-7. doi: 10.1245/s10434-009-0517-2.

De Broux E., Parc Y, Rondelli F., Dehni N., Tiret E., Parc R. Sutured perineal omentoplasty after abdominoperineal resection for adenocarcinoma of the lower rectum. Dis Colon Rectum. 2005 Mar; 48(3): 476-81.

de Campos-Lobato L.F., Stocchi L., Dietz D.W., Lavery I.C., Fazio VW., Kalady M.F. Prone or lithotomy positioning during an abdominoperineal resection for rectal cancer results in comparable oncologic outcomes. Dis Colon Rectum. 2011 Aug; 54(8): 939-46. doi: 10.1097/DCR.0b013e318221eb64.

Shukla H.S., Hughes L.E. The rectus abdominis flap for perineal wounds. Ann R Coll Surg Engl. 1984 Sep; 66(5): 337-9.

Butler C.E., Gundeslioglu A.O., Rodriguez-BigasM.A. Outcomes of immediate vertical rectus abdominis myocutaneous flap reconstruction for irradiated abdominoperineal resection defects. J Am Coll Surg. 2008 Apr; 206(4): 694-703. doi: 10.1016/j.jamcollsurg.2007.12.007.

Lefevre J.H., Parc Y., Kerneis S., Shields C., TouboulE., ChaouatM., Tiret E. Abdomino-perineal resection for anal cancer: impact of a vertical rectus abdominis myocutaneus flap on survival, recurrence, morbidity, and wound healing. Ann Surg. 2009 Nov; 250(5): 707-11. doi: 10.1097/SLA.0b013e3181bce334.

Singh B., Lloyd G., Nilsson P.J., Chaudhri S. Laparoscopic extralevator abdominal perineal excision of the rectum: the best of both worlds. Tech Coloproctol. 2012 Feb; 16(1): 73-5. doi: 10.1007/s10151-011-0797-y.

SpasojevicM.,MariathasanA.B., GoscinskiM., ThorgersenE.B., Solbakken A.M., GullestadH.P., Ryder T., FlatmarkK., Larsen S.G. Vertical Rectus Abdominis Musculocutaneous Flap Repair Improves Perineal Wound Healing after Abdominoperineal Resection for Irradiated Locally Advanced Rectal Cancer. Ann Surg Oncol. 2018 May; 25(5): 1357-1365. doi: 10.1245/s10434-018-6363-3.

Bartholdson L., Hulten L. Repair of persistent perineal sinuses by means of a pedicle flap of musculus gracilis. Case report. Scand J Plast Reconstr Surg 1975; 9(1): 74-6. doi: 10.3109/02844317509022861.

Shibata D., Hyland W., Busse P., Kim H.K., Sentovich S.M., Steele G.Jr., Bleday R. Immediate Reconstruction of the Perineal Wound With Gracilis Muscle Flaps Following Abdominoperineal Resection and Intraoperative Radiation Therapy for Recurrent Carcinoma of the Rectum. Ann Surg Oncol. 1999 Jan-Feb; 6(1): 33-7. doi: 10.1007/s10434-999-0033-4.

PersichettiP., CogliandroA., G.F., SimoneP., Ripetti V., Vitelli C.E., Coppola R. Pelvic and perineal reconstruction following abdominoperineal resection: the role of gracilis flap. Ann Plast Surg. 2007 Aug; 59(2): 168-72. doi: 10.1097/01.sap.0000252693.53692.e0.

Nisar P.J., Scott H.J. Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision. Colorectal Dis. 2009 Oct; 11(8): 806-16. doi: 10.nn/j.1463-1318.2008.01743.x

Stein M.J., Karir A., Ramji M., Allen M., Bain J.R., Avram R., Boushey R., Auer R., Jarmuske M. Surgical outcomes of VRAM versus gracilis flaps for the reconstruction of pelvic defects following oncologic resection. J Plast Reconstr Aesthet Surg. 2019 Apr; 72(4): 565-571. doi: 10.1016/j.bjps.2018.12.044.

Baird W.L., Hester T.R., Nahai F., Bostwick J. 3rd. Management of perineal wounds following abdominoperineal resection with inferior gluteal flaps. Arch Surg 1990; 125(11): 1486-9. doi: 10.1001/archsurg.1990.01410230080014.

Anderin C., Martling A., Lagergren J., Ljung A., Holm T. Shortterm outcome after gluteus maximus myocutaneous flap reconstruction of the pelvic floor following extralevator abdominoperineal excision of the rectum. Colorectal Dis. 2012 Sep; 14(9): 1060M. doi: 10.1111/j.1463-1318.2011.02848.x.

HaapamakiM.M., Pihlgren V, Lundberg O., SandzenB., Rutegard J. Physical Performance and Quality of Life After Extended Abdominoperineal Excision of Rectum and Reconstruction of the Pelvic Floor With Gluteus Maximus Flap. Dis Colon Rectum. 2011 Jan; 54(1): 101-6. doi: 10.1007/DCR.0b013e3181fce26e.

Foster J.D., Pathak S., SmartN.J., Branagan G., Longman R.J., Thomas M.G., Francis N. Reconstruction of the perineum following extralevator abdominoperineal excision for carcinoma of the lower rectum: a systematic review. Colorectal Dis. 2012 Sep; 14(9): 1052-9. doi: 10.1111/j.1463-1318.2012.03169.x.

Cui J., Ma J.P, Xiang J., Luo Y.X., Cai S.R., Huang Y.H., Wang , He Y.L. Prospective study of reconstructing pelvic floor with GORE-TEX Dual Mesh in abdominoperineal resection. Chin Med J (Engl) 2009; 122(18): 2138-41.

Christensen H.K., Nerstrom P, Tei T., Laurberg S. Perineal repair after extralevator abdominoperineal excision for low rectal cancer. Dis Colon Rectum. 2011 Jun; 54(6): 711-7. doi: 10.1007/DCR.0b013e3182163c89.

Han J.G., Wang ZJ., Qian Q., Dai Y, Zhang Z.Q., Yang J.S., LiF., Li X.B. A prospective multicenter clinical study of extralevator abdominoperineal resection for locally advanced low rectal cancer. Dis Colon Rectum. 2014 Dec; 57(12): 1333-40. doi: 10.1097/DCR.0000000000000235.

Musters G.D., Klaver C.E.L., Bosker R.J.I., Burger J.W.A., van Duijvendijk P, van Etten B., van Geloven A.A.W., de Graaf EJ.R., Hoff C., Leijtens J.W.A., Rutten H.J.T., Singh B., Vuylsteke R.J.C.LM., de Wilt J.H.W., DijkgraafM.G.W., Bemelman W.A., TanisPJ. Biological Mesh Closure of the Pelvic Floor After Extralevator Abdominoperineal Resection for Rectal Cancer: A Multicenter Randomized Controlled Trial (the BIOPEX-study). Ann Surg. 2017 Jun; 265(6): 1074-1081. doi: 10.1097/SLA.0000000000002020.

Pascual G., Sotomayor S., Pe P, J., J.M. Long term behavior of biological prostheses used as abdominal wall substitutes. Histol Histopathol. 2014 Jan; 29(1): 139-49. doi: 10.14670/HH-29.139.

Musters G.D., Buskens C.J., Bemelman W.A., Tanis PJ. Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum. 2014 Sep; 57(9): 1129-39. doi: 10.1097/DCR.0000000000000182.

McMenamin DM., Clements D., Edwards T.J., Fitton A.R., Douie W.J. Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large singlecentre experience. Ann R Coll Surg Engl. 2011 Jul; 93(5): 375-81. doi: 10.1308/003588411X572268.

PeacockO., PandyaH., Sharp T., HurstN.G., Speake W.J., Tierney G.M., Lund J.N. Biological mesh reconstruction of perineal wounds following enhanced abdominoperineal excision of rectum (APER). Int J Colorectal Dis. 2012 Apr; 27(4): 475-82. doi: 10.1007/s00384-011-1325-2.

FitzGerald J.F., Kumar A.S. Biologic versus Synthetic Mesh Reinforcement: What are the Pros and Cons? Clin Colon Rectal Surg. 2014 Dec; 27(4): 140-8. doi: 10.1055/s-0034-1394155.

The authors declare that there are no conflicts of interest present.