Comparison of Outcomes in Oncoplastic Pelvic Reconstruction with VRAM versus Omental Flaps: A Large Cohort Analysis

Arif Chaudhry, Jeremie D. Oliver, Krishna S. Vyas, Nho V. Tran, Jorys Martinez-Jorge, David Larson, Eric Dozois, Heidi Nelson, Oscar J. Manrique

Research output: Contribution to journalArticle

Abstract

Background The purpose of this study is to describe our experience and outcomes in oncoplastic pelvic reconstruction for patients who underwent either vertical rectus abdominis musculocutaneous (VRAM) or omental flap following abdominoperineal resection (APR) at a single tertiary care institution. Methods All patients who underwent pelvic reconstruction following APR with either VRAM or omental flaps from January 1992 to January 2017 were retrospectively reviewed. Patient demographics and relevant comorbidities including chemotherapy and radiation therapy data were collected and analyzed. In addition, margin status at the time of oncologic resection was analyzed. Flap-specific data were collected for each approach. Oncologic data collected included cancer type, stage at time of APR, and rate of tumor recurrence within the flap. Results A total of 562 patients were identified who underwent pelvic reconstruction with either VRAM or omental pedicle flaps. Of these, 274 (48.8%) underwent VRAM reconstruction and 288 (51.2%) underwent omental flap reconstruction. All margins were negative at time of cancer ablation surgery. Complications data included: seroma (VRAM = 2 [0.36%]; omentum = 32 [5.69%], p < 0.0001), wound dehiscence (VRAM = 31 [5.52%]; omentum = 17 [3.02%], p = 0.022), abscess (VRAM = 4 [0.71%]; omentum = 27 [4.8%], p < 0.0001), cellulitis (VRAM = 2 [0.36%]; omentum = 10 [1.78%], p = 0.025). Statistical comparison of tumor recurrence between these two reconstructive approaches showed a significantly higher recurrence rate in omental flaps compared with VRAM flaps (p = 0.000127). Conclusion The results of this study suggest a significantly higher tumor recurrence rate in omental flap pelvic reconstruction compared with VRAM flaps. This knowledge has the potential to influence surgical planning and flap selection in pelvic reconstruction.

Original languageEnglish (US)
Pages (from-to)425-429
Number of pages5
JournalJournal of Reconstructive Microsurgery
Volume35
Issue number6
DOIs
StatePublished - Jan 1 2019

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Rectus Abdominis
Cohort Studies
Omentum
Recurrence
Myocutaneous Flap
Neoplasms
Seroma
Surgical Flaps
Cellulitis
Tertiary Healthcare
Abscess
Comorbidity
Radiotherapy
Demography
Drug Therapy

Keywords

  • omentum
  • pelvic reconstruction
  • VRAM

ASJC Scopus subject areas

  • Surgery

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Comparison of Outcomes in Oncoplastic Pelvic Reconstruction with VRAM versus Omental Flaps : A Large Cohort Analysis. / Chaudhry, Arif; Oliver, Jeremie D.; Vyas, Krishna S.; Tran, Nho V.; Martinez-Jorge, Jorys; Larson, David; Dozois, Eric; Nelson, Heidi; Manrique, Oscar J.

In: Journal of Reconstructive Microsurgery, Vol. 35, No. 6, 01.01.2019, p. 425-429.

Research output: Contribution to journalArticle

Chaudhry, Arif ; Oliver, Jeremie D. ; Vyas, Krishna S. ; Tran, Nho V. ; Martinez-Jorge, Jorys ; Larson, David ; Dozois, Eric ; Nelson, Heidi ; Manrique, Oscar J. / Comparison of Outcomes in Oncoplastic Pelvic Reconstruction with VRAM versus Omental Flaps : A Large Cohort Analysis. In: Journal of Reconstructive Microsurgery. 2019 ; Vol. 35, No. 6. pp. 425-429.
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abstract = "Background The purpose of this study is to describe our experience and outcomes in oncoplastic pelvic reconstruction for patients who underwent either vertical rectus abdominis musculocutaneous (VRAM) or omental flap following abdominoperineal resection (APR) at a single tertiary care institution. Methods All patients who underwent pelvic reconstruction following APR with either VRAM or omental flaps from January 1992 to January 2017 were retrospectively reviewed. Patient demographics and relevant comorbidities including chemotherapy and radiation therapy data were collected and analyzed. In addition, margin status at the time of oncologic resection was analyzed. Flap-specific data were collected for each approach. Oncologic data collected included cancer type, stage at time of APR, and rate of tumor recurrence within the flap. Results A total of 562 patients were identified who underwent pelvic reconstruction with either VRAM or omental pedicle flaps. Of these, 274 (48.8{\%}) underwent VRAM reconstruction and 288 (51.2{\%}) underwent omental flap reconstruction. All margins were negative at time of cancer ablation surgery. Complications data included: seroma (VRAM = 2 [0.36{\%}]; omentum = 32 [5.69{\%}], p < 0.0001), wound dehiscence (VRAM = 31 [5.52{\%}]; omentum = 17 [3.02{\%}], p = 0.022), abscess (VRAM = 4 [0.71{\%}]; omentum = 27 [4.8{\%}], p < 0.0001), cellulitis (VRAM = 2 [0.36{\%}]; omentum = 10 [1.78{\%}], p = 0.025). Statistical comparison of tumor recurrence between these two reconstructive approaches showed a significantly higher recurrence rate in omental flaps compared with VRAM flaps (p = 0.000127). Conclusion The results of this study suggest a significantly higher tumor recurrence rate in omental flap pelvic reconstruction compared with VRAM flaps. This knowledge has the potential to influence surgical planning and flap selection in pelvic reconstruction.",
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T1 - Comparison of Outcomes in Oncoplastic Pelvic Reconstruction with VRAM versus Omental Flaps

T2 - A Large Cohort Analysis

AU - Chaudhry, Arif

AU - Oliver, Jeremie D.

AU - Vyas, Krishna S.

AU - Tran, Nho V.

AU - Martinez-Jorge, Jorys

AU - Larson, David

AU - Dozois, Eric

AU - Nelson, Heidi

AU - Manrique, Oscar J.

PY - 2019/1/1

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N2 - Background The purpose of this study is to describe our experience and outcomes in oncoplastic pelvic reconstruction for patients who underwent either vertical rectus abdominis musculocutaneous (VRAM) or omental flap following abdominoperineal resection (APR) at a single tertiary care institution. Methods All patients who underwent pelvic reconstruction following APR with either VRAM or omental flaps from January 1992 to January 2017 were retrospectively reviewed. Patient demographics and relevant comorbidities including chemotherapy and radiation therapy data were collected and analyzed. In addition, margin status at the time of oncologic resection was analyzed. Flap-specific data were collected for each approach. Oncologic data collected included cancer type, stage at time of APR, and rate of tumor recurrence within the flap. Results A total of 562 patients were identified who underwent pelvic reconstruction with either VRAM or omental pedicle flaps. Of these, 274 (48.8%) underwent VRAM reconstruction and 288 (51.2%) underwent omental flap reconstruction. All margins were negative at time of cancer ablation surgery. Complications data included: seroma (VRAM = 2 [0.36%]; omentum = 32 [5.69%], p < 0.0001), wound dehiscence (VRAM = 31 [5.52%]; omentum = 17 [3.02%], p = 0.022), abscess (VRAM = 4 [0.71%]; omentum = 27 [4.8%], p < 0.0001), cellulitis (VRAM = 2 [0.36%]; omentum = 10 [1.78%], p = 0.025). Statistical comparison of tumor recurrence between these two reconstructive approaches showed a significantly higher recurrence rate in omental flaps compared with VRAM flaps (p = 0.000127). Conclusion The results of this study suggest a significantly higher tumor recurrence rate in omental flap pelvic reconstruction compared with VRAM flaps. This knowledge has the potential to influence surgical planning and flap selection in pelvic reconstruction.

AB - Background The purpose of this study is to describe our experience and outcomes in oncoplastic pelvic reconstruction for patients who underwent either vertical rectus abdominis musculocutaneous (VRAM) or omental flap following abdominoperineal resection (APR) at a single tertiary care institution. Methods All patients who underwent pelvic reconstruction following APR with either VRAM or omental flaps from January 1992 to January 2017 were retrospectively reviewed. Patient demographics and relevant comorbidities including chemotherapy and radiation therapy data were collected and analyzed. In addition, margin status at the time of oncologic resection was analyzed. Flap-specific data were collected for each approach. Oncologic data collected included cancer type, stage at time of APR, and rate of tumor recurrence within the flap. Results A total of 562 patients were identified who underwent pelvic reconstruction with either VRAM or omental pedicle flaps. Of these, 274 (48.8%) underwent VRAM reconstruction and 288 (51.2%) underwent omental flap reconstruction. All margins were negative at time of cancer ablation surgery. Complications data included: seroma (VRAM = 2 [0.36%]; omentum = 32 [5.69%], p < 0.0001), wound dehiscence (VRAM = 31 [5.52%]; omentum = 17 [3.02%], p = 0.022), abscess (VRAM = 4 [0.71%]; omentum = 27 [4.8%], p < 0.0001), cellulitis (VRAM = 2 [0.36%]; omentum = 10 [1.78%], p = 0.025). Statistical comparison of tumor recurrence between these two reconstructive approaches showed a significantly higher recurrence rate in omental flaps compared with VRAM flaps (p = 0.000127). Conclusion The results of this study suggest a significantly higher tumor recurrence rate in omental flap pelvic reconstruction compared with VRAM flaps. This knowledge has the potential to influence surgical planning and flap selection in pelvic reconstruction.

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