Evaluating negative-pressure wound therapy after abdominoperineal resection: a systematic review of efficacy and technical variability - Report - MDSpire
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Evaluating negative-pressure wound therapy after abdominoperineal resection: a systematic review of efficacy and technical variability
Clinical Report: Negative-Pressure Wound Therapy After Abdominoperineal Resection
Overview
Negative-pressure wound therapy (NPWT), especially prophylactic NPWT (pNPWT), shows promise in reducing perineal wound complications following abdominoperineal resection (APR). Despite encouraging early results, variability in device types, pressure settings, and patient factors complicates definitive conclusions on its efficacy and optimal use.
Background
Low rectal and anal cancers often require abdominoperineal resection (APR), which involves removal of the distal colon, rectum, anus, and sphincters, resulting in a permanent colostomy. APR is associated with high rates of perineal wound complications, including surgical site infections (SSIs), wound dehiscence, and delayed healing, especially in patients receiving neoadjuvant chemoradiotherapy. Traditional closure techniques frequently fail to prevent these complications due to tissue damage from radiotherapy and extensive resections. Negative-pressure wound therapy (NPWT) has emerged as a potential strategy to improve wound healing by promoting granulation, enhancing perfusion, and reducing bacterial load.
Data Highlights
Perineal wound complications occur in up to 50% of APR patients. Preoperative radiotherapy nearly doubles the risk of wound complications. NPWT devices vary: canister-based systems apply ~−125 mmHg pressure, while portable canisterless systems apply −70 to −80 mmHg. Early studies suggest pNPWT reduces SSI rates and improves healing times, but pooled evidence remains limited and inconsistent.
Key Findings
APR carries a high risk of perineal wound complications, significantly impacting patient recovery and quality of life.
Preoperative radiotherapy and chemoradiotherapy exacerbate wound healing difficulties due to tissue hypoxia, fibrosis, and impaired angiogenesis.
NPWT mechanisms include subatmospheric pressure application that promotes granulation tissue formation and reduces bacterial load.
Prophylactic NPWT (pNPWT) applied to closed incisions may reduce SSIs and wound dehiscence in high-risk APR patients.
Device types and settings vary widely, with canister-based systems delivering higher negative pressures than portable systems.
Evidence on the long-term efficacy, cost-effectiveness, and optimal patient selection for pNPWT remains inconclusive, necessitating further research.
Clinical Implications
Clinicians should consider pNPWT as a promising adjunct to reduce perineal wound complications following APR, particularly in patients with risk factors such as preoperative radiotherapy or high BMI. Selection of NPWT device type and pressure settings should be individualized, balancing efficacy with patient comfort and resource availability. Ongoing evaluation and adherence to evolving protocols are essential to optimize wound outcomes.
Conclusion
Negative-pressure wound therapy represents a valuable tool in managing perineal wounds after APR, with prophylactic application showing potential benefits. However, further high-quality studies are needed to standardize its use and confirm long-term advantages.
