Clinical analysis of 6 cases of functional perineal reconstruction in posterior pelvic exenteration for female patients
CHANG Yi
JIANG Hui-hong
LI A-jian
DING Hai-bo
YANG Er-jiang
HUANG Ling
TANG Cui
SUN Cheng-yu
FANG Ya-ping
HUANG Jin
ZHANG Xiao-jian
WANG Song
LIN Yin
LIU Hai-long
FENG Shao-qing
LIN Mou-bin
Abstract：Objective To investigate the safety and feasibility of functional perineal reconstruction(reconstructing the anus and vagina function while repairing perineal defect)in posterior pelvic exenteration(PPE).Methods A retrospective analysis was conducted on the clinical data of6 female patients with locally advanced or recurrent rectal and anal cancer who underwent PPE and functional perineal reconstruction at Yangpu Hospital affiliated to Tongji University School of Medicine from November 2023 to July 2024.Results All 6 patients received PPE with a combination of gracilis flap and different perforator flaps,which simultaneously restored the anus,repaired the vagina,closed the perineal defect,and filled the pelvic space.1 patient received a gracilis flap,3 patients received a compound gracilis myocutaneous flap,and 2 patients received a combined gracilis flap with profunda artery perforator flap.The mean duration for complete posterior exenteration was(405±86.2)min.The mean duration for muscle flap excision and pelvic floor reconstruction was(155±37.4)min.The median blood loss was 260(280,410)mL.The median postoperative stay was 15(14,20)days.All patients successfully repaired the vagina,but one patient had an infected perineal incision that healed after 2 weeks of dressing changes.5 patients have completed the primary biofeedback program,and the maximum squeeze pressure was(213.8±15.4)mmHg and continuous extrusion time was(14.3±1.0)s of the reconstructed anus.3 patients have completed the advanced biofeedback program,and the anal resting pressure was(56.2±18.6)mmHg and high pressure zone was(2.6±0.5)cm of the reconstructed anus.The median follow-up time of the 6 patients was 5.8(3.5,7.1)months,and no signs of tumor recurrence or metastasis were found,nor was necrosis or atrophy of the myocutaneous flap observed.Conclusion For locally advanced or recurrent rectal and anal cancer patients,it is safe and feasible to perform functional perineal reconstruction in PPE,which achieves the dual goals of tumor resection and organ function restoration.
Keywords：rectal and anal cancerposterior pelvic exenterationperineal reconstructionanal reconstructionbiofeedback therapy
Publication Date：2025-02-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 220-226 )