Vaginal Reconstruction Following Resection of Primary Locally Advanced and Recurrent Colorectal Malignancies

Dougal N. D'Souza, Miguel Pera, Heidi Nelson, Stephan J. Finical, Nho V. Tran

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Hypotheses: Vertical rectus abdominus myocutaneous flap reconstruction facilitates healing within the radiated pelvis and preserves the possibility of subsequent sexual function in patients with colorectal cancer who require partial or complete resection of the vagina. Design: A retrospective review of a consecutive series of patients. Setting: A tertiary referral center. Patients: All patients undergoing surgical treatment of locally advanced or recurrent colorectal cancer and vertical rectus abdominus myocutaneous flap reconstruction of the vagina. Intervention: Vertical rectus abdominus myocutaneous flap reconstruction. Main Outcome Measures: Operative feasibility, complications, and sexual function. Results: Twelve patients underwent extended resection for primary locally advanced or recurrent colorectal cancer including total or near total vaginectomy. Median age was 47 years. Tumors included 9 rectal adenocarcinomas, 2 anal squamous cell carcinomas, and 1 recurrent cecal adenocarcinoma. Surgical procedures included 8 abdominoperineal resections with posterior exenteration; resection of pelvic tumor and partial vaginectomy in 2 patients with previous abdominoperineal resection; 1 total exenteration; and 1 total proctocolectomy with posterior exenteration. The average operative time for tumor extirpation, irradiation, and reconstruction was more than 9 hours and all patients required blood transfusions. Despite 2 patients having superficial necrosis and 4 having mild wound infections, no patient required reoperation and all achieved complete healing. Five patients reported resuming sexual intercourse. Conclusions: The vertical rectus abdominus myocutaneous flap can be successfully used for vaginal reconstruction following resection of locally advanced colorectal cancer. It provides nonirradiated, vascularized tissue that fills the pelvic dead space, allows for stomal placement, and provides a chance for sexual function.

Original languageEnglish (US)
Pages (from-to)1340-1343
Number of pages4
JournalArchives of Surgery
Volume138
Issue number12
DOIs
StatePublished - Dec 2003

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Rectus Abdominis
Myocutaneous Flap
Neoplasms
Colorectal Neoplasms
Vagina
Adenocarcinoma
Coitus
Wound Infection
Operative Time
Pelvis
Reoperation
Tertiary Care Centers
Blood Transfusion
Squamous Cell Carcinoma
Necrosis
Outcome Assessment (Health Care)
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Vaginal Reconstruction Following Resection of Primary Locally Advanced and Recurrent Colorectal Malignancies. / D'Souza, Dougal N.; Pera, Miguel; Nelson, Heidi; Finical, Stephan J.; Tran, Nho V.

In: Archives of Surgery, Vol. 138, No. 12, 12.2003, p. 1340-1343.

Research output: Contribution to journalArticle

D'Souza, Dougal N. ; Pera, Miguel ; Nelson, Heidi ; Finical, Stephan J. ; Tran, Nho V. / Vaginal Reconstruction Following Resection of Primary Locally Advanced and Recurrent Colorectal Malignancies. In: Archives of Surgery. 2003 ; Vol. 138, No. 12. pp. 1340-1343.
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