Immediate Reconstruction After Colorectal Cancer Resection: A Cohort Analysis Through the National Surgical Quality Improvement Program and Outcomes Review.

BACKGROUND: Colorectal cancer is one of the most common and fatal malignancies in the United States. When localized to the distal gastrointestinal tract, surgical therapy includes abdominoperineal resection (APR) or pelvic exenteration (PEX). Subsequent ablative defects are considerable, impart concerning morbidity, and often necessitate autologous reconstruction. The aim of this study was to assess postoperative outcomes after reconstruction of APR and PEX defects. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (2005-2017) was queried for patients undergoing APR for lower gastrointestinal malignancies with concurrent autologous reconstructions. Cases of disseminated cancer were excluded. Postoperative adverse event profiles, including rates of wound and systemic complications, were evaluated. Multivariate regression analysis controlling for age, sex, body mass index, and operative time was performed to calculate adjusted odds ratios (ORs). RESULTS: A total of 1309 patients were identified as undergoing APR/PEX with concomitant reconstruction. The majority (96.9%) of reconstructions consisted of muscle, myocutaneous, fasciocutaneous, or omental pedicled flaps. Of the cohort, 45.7% experienced at least 1 all-cause complication within 30-days of the procedure. Having a limited or moderate frailty (frailty index of "1" or "2") was identified as a predictor of all-cause complications [OR, 1.556; 95% confidence interval (CI), 1.187-2.040, P = 0.001; and OR, 1.741; 95% CI, 1.193-2.541, P = 0.004, respectively], whereas smoking was a predictor of wound complications (OR, 1.462; 95% CI, 1.070-1.996, P = 0.017) and steroid use was a predictor of mild systemic complications (OR, 2.006; 95% CI, 1.058-3.805, P = 0.033). CONCLUSION: Anorectal cancer resection often necessitates reconstruction secondary to postexenteration perineal defects. The incidence of postoperative complications is relatively high, and several risk factors are identified to help refine patient optimization.

Impact of Obesity on Outcomes in Breast Reconstruction: A Systematic Review and Meta-Analysis.

BACKGROUND: Increased rates of both breast cancer and obesity have resulted in more obese women seeking breast reconstruction. Studies demonstrate that these women are at increased risk for perioperative complications. A systematic review was conducted to assess the outcomes in obese women who underwent breast reconstruction following mastectomy. METHODS: Cochrane, PUBMED, and EMBASE electronic databases were screened and data were extracted from included studies. The clinical outcomes assessed were surgical complications, medical complications, length of postoperative hospital stay, reoperation rate, and patient satisfaction. RESULTS: Out of 33 studies met the inclusion criteria for the review and 29 provided enough data to be included in the meta-analysis (71,368 patients, 20,061 of whom were obese). Obese women (body mass index > 30 kg/m2) were 2.29 times more likely to experience surgical complications (95% confidence interval (CI) 2.19-2.39; p < 0.00001), 2.89 times more likely to have medical complications (95% CI 2.50-3.35; p < 0.00001), and had a 1.91 times higher risk of reoperation (95% CI 1.75-2.07; p < 0.00001). The most common complication, wound dehiscence, was 2.51 times more likely in obese women (95% CI 1.80-3.52; p < 0.00001). Sensitivity analysis confirmed that obese women were more likely to experience surgical complications (risk ratio 2.36, 95% CI 2.22-2.52; p < 0.00001). CONCLUSIONS: This study provides evidence that obesity increases the risk of complications in both implant-based and autologous reconstruction. Additional prospective and observational studies are needed to determine if the weight reduction prior to reconstruction reduces the perioperative risks associated with obesity.

Impact of obesity on outcomes in breast reconstruction: A systematic review protocol.

INTRODUCTION: The worldwide obesity epidemic is creating new challenges for surgeons involved in breast reconstruction. This systematic review aims to summarise the research available in order to determine the surgical and medical complications, the duration of surgery and post-operative hospital stay and the likelihood of reoperation in each of the different techniques of breast reconstruction in women with obesity. To our knowledge, no systematic review is currently available that assesses the impact of obesity on breast reconstruction outcomes. METHODS AND ANALYSIS: Electronic searches will be conducted on Cochrane, PUBMED and EMBASE, from their inception to 1 June 2016. All cohort studies, case series, randomised controlled trials, and case-control studies on women undergoing breast reconstruction post mastectomy for oncological reasons will be included. Articles must mention at least one of the primary outcomes of interest. Full exclusion and inclusion criteria are described within this protocol. Primary and secondary outcomes are described within this protocol. The search strategy, described within this protocol, aims to identify all articles on "obesity and breast reconstruction." DISCUSSION: This paper outlines the study protocol for a systematic literature review that will identify and summarise currently available evidence on the effectiveness and complications of breast reconstructive procedures in women with a BMI >30 kg/m2. This review aims to provide an overview of the evidence in order to create a guide for healthcare professionals involved in the breast reconstruction of obese women. DISSEMINATION: This review will be published in a peer-reviewed journal and will be presented at various national and international conferences.

Outcome analysis of 244 consecutive flaps for managing complex groin wounds.

BACKGROUND: Complex groin wounds present a significant challenge to the reconstructive surgeon. We present a large experience of flaps for managing complex groin wounds. The purpose of our study was to assess outcomes with respect to flap selection and indication (prophylactic versus salvage). PATIENTS AND METHODS: A retrospective review of all patients receiving flaps for complex groin wounds between 2005 and 2011 was performed. Two types of procedures were evaluated: prophylactic muscle flaps (PMFs) and salvage flaps. We performed an outcome analysis of complications based on flap timing and selection. RESULTS: A total of 244 flaps were performed during the study period: 146 flaps for salvage and 98 for prophylaxis. Flaps included: sartorius muscle flap (SMF) (N=132), rectus femoris flap (RFF) (N=99), and antero-lateral thigh (ALT) (N=13). Salvaged wounds had higher rates of major wound dehiscence compared to prophylactic wounds (P=0.002). The SMF (N=132) and RFF (N=99) cohorts were similar with respect to patient and operative characteristics, however, the RFF cohort tended to be obese (P=0.002), used for salvage (P=0.0005), endarterectomy procedures (P=0.018), and culture positive wounds (P=0.09). Major limb related complications (graft loss, limb loss, and reoperation) were significantly lower in the RFF group (P=0.03). CONCLUSIONS: Muscle flaps for complex groin wounds can be safely performed with excellent outcomes. We suggest use of the SMF in the prophylactic setting and for smaller salvage wounds. The RFF may be better suited to address larger, more complex wounds. PMFs in select, high-risk patients optimize wound healing relative to patients undergoing groin wound salvage. LEVEL OF EVIDENCE: Prognostic/risk category, level III.