QS137 - Pedicled omental flaps are effective for reducing post-operative complications after abdominoperineal resection for rectal cancer

Sunday, May 11, 2025

4:27 PM – 4:31 PM PT

Location: Room 9, Upper Level

Quick Shot Presenter(s)

MG

Montserrat Guraieb-Trueba, MD

Assistant Professor
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
Houston, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Teppei Miyakawa, MD, MPH

Postdoctoral fellow
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
Houston, TX, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Kentaro Ochiai, MD

Visiting scientist
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
Abhineet Uppal, MD

Assistant professor
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
Craig A. Messick, M.D., FACS, FASCRS

Associate professor
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
BB

Brian Keith Bednarski, M.D., MHEP, FACS

Associate professor
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
Houston, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Tsuyoshi Konishi, M.D., PhD.

Associate professor
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
DA

David M Adelman, M.D., Ph.D., F.A.C.S.

Professor
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
CN

Christopher M. Nguyen, M.D., FRCSC

Assistant Professor
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
MR

Margaret S. Roubaud, M.D.

Associate Professor
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
Y. Nancy You, MD, MHSc

Professor
University of Texas MD Anderson Cancer Center

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

George J J. Chang, M.D., M.Sc., MHCM, FACS, FASCRS, FSSO (he/him/his)

Chair Ad Interim and Professor
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
Medicaroid: Consultant (Ongoing); Tempus: Honoraria (Ongoing)

All of the relevant financial relationships listed below have been mitigated.

Montserrat Guraieb-Trueba, MD: This individual has no financial relationships with ineligible companies.

Teppei Miyakawa, MD, MPH: This individual has no financial relationships with ineligible companies.

Brian Keith Bednarski, M.D., MHEP, FACS: This individual has no financial relationships with ineligible companies.

Y. Nancy You, MD, MHSc: This individual has no financial relationships with ineligible companies.

George J J. Chang, M.D., M.Sc., MHCM, FACS, FASCRS, FSSO: Medicaroid: Consultant (Ongoing); Tempus: Honoraria (Ongoing)

Image or Table (Do Not add text here):

Purpose/Background: Perineal wound complications occur in approximately 50% of patients undergoing abdominoperineal resection (APR) for primary rectal cancer. Vertical rectus abdominis myocutaneous (VRAM) flaps have been associated with reduced perineal wound complications but may increase morbidity. Omental flaps are an alternative for reconstruction especially in the era of minimally invasive surgery (MIS), but their effectiveness remains unclear. We hypothesized that pedicled omental flaps would reduce perineal wound complications compared to non-pedicled omental flaps or no flap, with outcomes comparable to VRAM. This study aimed to compare outcomes in pedicled omental flaps versus non-pedicled omental flaps, VRAM flaps, and no flap.

Methods/Interventions: A retrospective observational consecutive cohort study was performed of patients who underwent APR for primary rectal cancer without pelvic multi-organ resection between 2016 and 2023. Patients were identified from prospectively maintained database and divided into pedicled omental flap (omentum mobilized WITH division of short gastric), non-pedicled omental flap (mobilized WITHOUT division of short gastric), VRAM, and no flap groups. Primary outcome was perineal wound complication including wound dehiscence, wound infection, or pelvic abscess. Secondary outcomes included early and late abdominal wall complications (dehiscence, infection, incisional or parastomal hernia). Outcomes for pedicled omental flaps were compared to other groups using univariate analysis.

Results/Outcomes: Of 212 patients (110 open, 102 MIS), 56 (26.4%) received pedicled omental flaps, 73 (34.4%) non-pedicled omental flaps, 63 (29.7%) VRAM flaps, and 20 (9.4%) no flap. MIS was performed in 47 (83.9%), 39 (53.4%), 3 (4.8%), and 13 (65%) of patients in the pedicled omental flap, non-pedicled omental flap, VRAM, and no flap groups, respectively. Patients with pedicled omental flaps had lower rates of perineal wound complications (n=11, 19.6%) when compared to non-pedicled omental flap (n=27, 37.0%, p=0.03), or no flap (n=7, 35%, p=0.17), but not VRAM (n=10, 15.9%, p=0.59). Abdominal wall complications were less frequent with pedicled omental flap (n=18, 32.1%) when compared to VRAM (n=32, 50.8%, p=0.04) but not when compared to non-pedicled omental flap (n=27, 37%, p=0.57), or no flap (n=10, 50%, p=0.15).

Conclusion/Discussion: Pedicled omental flaps were associated with lower rates of perineal wound complications when compared to non-pedicled omental flaps and lower rates of abdominal wall complications when compared to VRAM. Pedicled omental flaps but not non-pedicled flaps offer an effective alternative for pelvic reconstruction particularly after MIS abdominal perineal resection.