Pelvic reconstruction of the retroperitoneum after abdominoperineal resection of the rectum using full-thickness skin grafts.

BACKGROUND: To find a safe and effective method of pelvic reconstruction after abdominoperineal resection in order to prevent small intestine from descending into the pelvis. This allows safe delivery of optimal doses of radiation therapy, which exceed radiation tolerance of the small intestine, in advanced stages of colorectal cancer. MATERIALS: Prospective, ongoing study examining patients who underwent abdominoperineal resection and pelvic reconstruction with full-thickness skin grafts. METHODS: Nine (9) patients underwent abdominoperineal resection of the rectum and pelvic reconstruction with full-thickness skin grafts for colorectal cancer stage C. Subsequently they were referred for adjuvant radiation therapy and followed up regularly for surgical complications and disease recurrence. RESULTS: All patients successfully completed postoperative radiation therapy and there were no serious surgical complications pertaining to the initial operation and the skin homeotransplantation. None of the patients needed reoperation, so the long-term outcome of the transplantation was not surgically evaluated. CONCLUSIONS: Reconstruction of the peritoneal gap after abdominoperineal resection of the rectum with full-thickness skin graft is a safe and effective method. The small intestine was effectively excluded from the pelvis allowing successful completion of adjuvant radiation therapy with minimal irradiation of the small intestine and effective prevention of radiation enteritis.