A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer

Robin D Blok; Jan A W Hagemans; Charlotte E L Klaver; Joke Hellinga; Boudewijn van Etten; Jacobus W A Burger; Cornelis Verhoef; Roel Hompes; Wilhelmus A Bemelman; Pieter J Tanis

doi:10.1097/SLA.0000000000003266

A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer

Robin D Blok
, Jan A W Hagemans
, Charlotte E L Klaver
, Joke Hellinga
, Boudewijn van Etten
, Jacobus W A Burger
, Cornelis Verhoef
, Roel Hompes
, Wilhelmus A Bemelman
, Pieter J Tanis^*

^*Corresponding author for this work

Surgery

Research output: Contribution to journal › Article › Academic › peer-review

31 Citations (Scopus)

147 Downloads (Pure)

Abstract

OBJECTIVE:

The objective of this systematic review and meta-analysis was to examine the effects of omentoplasty on pelviperineal morbidity following abdominoperineal resection (APR) in patients with cancer.

BACKGROUND:

Recent studies have questioned the use of omentoplasty for the prevention of perineal wound complications.

METHODS:

A systematic review of published literature since 2000 on the use of omentoplasty during APR for cancer was undertaken. The authors were requested to share their source patient data. Meta-analyses were conducted using a random-effects model.

RESULTS:

Fourteen studies comprising 1894 patients (n = 839 omentoplasty) were included. The majority had APR for rectal cancer (87%). Omentoplasty was not significantly associated with the risk of presacral abscess formation in the overall population (RR 1.11; 95% CI 0.79-1.56), nor in planned subgroup analysis (n = 758) of APR with primary perineal closure for nonlocally advanced rectal cancer (RR 1.06; 95% CI 0.68-1.64). No overall differences were found for complicated perineal wound healing within 30 days (RR 1.30; 95% CI 0.92-1.82), chronic perineal sinus (RR 1.08; 95% CI 0.53-2.20), and pelviperineal complication necessitating reoperation (RR 1.06; 95% CI 0.80-1.42) as well. An increased risk of developing a perineal hernia was found for patients submitted to omentoplasty (RR 1.85; 95% CI 1.26-2.72). Complications related to the omentoplasty were reported in 4.6% (95% CI 2.5%-8.6%).

CONCLUSIONS:

This meta-analysis revealed no beneficial effect of omentoplasty on presacral abscess formation and perineal wound healing after APR, while it increases the likelihood of developing a perineal hernia. These findings do not support the routine use of omentoplasty in APR for cancer.

Original language	English
Pages (from-to)	654-662
Number of pages	9
Journal	Annals of Surgery
Volume	271
Issue number	4
DOIs	https://doi.org/10.1097/SLA.0000000000003266
Publication status	Published - Apr 2020

Research programs

EMC OR-01

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1097/SLA.0000000000003266

Repub_128696.pdfFinal published version, 1 MBLicence: Article 25fa Dutch Copyright Act

Cite this

Blok, R. D., Hagemans, J. A. W., Klaver, C. E. L., Hellinga, J., van Etten, B., Burger, J. W. A., Verhoef, C., Hompes, R., Bemelman, W. A., & Tanis, P. J. (2020). A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer. Annals of Surgery, 271(4), 654-662. https://doi.org/10.1097/SLA.0000000000003266

@article{c5e0ef7614224e8389a0140ab473fa1d,

title = "A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer",

abstract = "OBJECTIVE: The objective of this systematic review and meta-analysis was to examine the effects of omentoplasty on pelviperineal morbidity following abdominoperineal resection (APR) in patients with cancer.BACKGROUND: Recent studies have questioned the use of omentoplasty for the prevention of perineal wound complications.METHODS: A systematic review of published literature since 2000 on the use of omentoplasty during APR for cancer was undertaken. The authors were requested to share their source patient data. Meta-analyses were conducted using a random-effects model.RESULTS: Fourteen studies comprising 1894 patients (n = 839 omentoplasty) were included. The majority had APR for rectal cancer (87\%). Omentoplasty was not significantly associated with the risk of presacral abscess formation in the overall population (RR 1.11; 95\% CI 0.79-1.56), nor in planned subgroup analysis (n = 758) of APR with primary perineal closure for nonlocally advanced rectal cancer (RR 1.06; 95\% CI 0.68-1.64). No overall differences were found for complicated perineal wound healing within 30 days (RR 1.30; 95\% CI 0.92-1.82), chronic perineal sinus (RR 1.08; 95\% CI 0.53-2.20), and pelviperineal complication necessitating reoperation (RR 1.06; 95\% CI 0.80-1.42) as well. An increased risk of developing a perineal hernia was found for patients submitted to omentoplasty (RR 1.85; 95\% CI 1.26-2.72). Complications related to the omentoplasty were reported in 4.6\% (95\% CI 2.5\%-8.6\%).CONCLUSIONS: This meta-analysis revealed no beneficial effect of omentoplasty on presacral abscess formation and perineal wound healing after APR, while it increases the likelihood of developing a perineal hernia. These findings do not support the routine use of omentoplasty in APR for cancer.",

author = "Blok, \{Robin D\} and Hagemans, \{Jan A W\} and Klaver, \{Charlotte E L\} and Joke Hellinga and \{van Etten\}, Boudewijn and Burger, \{Jacobus W A\} and Cornelis Verhoef and Roel Hompes and Bemelman, \{Wilhelmus A\} and Tanis, \{Pieter J\}",

year = "2020",

month = apr,

doi = "10.1097/SLA.0000000000003266",

language = "English",

volume = "271",

pages = "654--662",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "Wolters Kluwer Health",

number = "4",

}

TY - JOUR

T1 - A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer

AU - Blok, Robin D

AU - Hagemans, Jan A W

AU - Klaver, Charlotte E L

AU - Hellinga, Joke

AU - van Etten, Boudewijn

AU - Burger, Jacobus W A

AU - Verhoef, Cornelis

AU - Hompes, Roel

AU - Bemelman, Wilhelmus A

AU - Tanis, Pieter J

PY - 2020/4

Y1 - 2020/4

N2 - OBJECTIVE: The objective of this systematic review and meta-analysis was to examine the effects of omentoplasty on pelviperineal morbidity following abdominoperineal resection (APR) in patients with cancer.BACKGROUND: Recent studies have questioned the use of omentoplasty for the prevention of perineal wound complications.METHODS: A systematic review of published literature since 2000 on the use of omentoplasty during APR for cancer was undertaken. The authors were requested to share their source patient data. Meta-analyses were conducted using a random-effects model.RESULTS: Fourteen studies comprising 1894 patients (n = 839 omentoplasty) were included. The majority had APR for rectal cancer (87%). Omentoplasty was not significantly associated with the risk of presacral abscess formation in the overall population (RR 1.11; 95% CI 0.79-1.56), nor in planned subgroup analysis (n = 758) of APR with primary perineal closure for nonlocally advanced rectal cancer (RR 1.06; 95% CI 0.68-1.64). No overall differences were found for complicated perineal wound healing within 30 days (RR 1.30; 95% CI 0.92-1.82), chronic perineal sinus (RR 1.08; 95% CI 0.53-2.20), and pelviperineal complication necessitating reoperation (RR 1.06; 95% CI 0.80-1.42) as well. An increased risk of developing a perineal hernia was found for patients submitted to omentoplasty (RR 1.85; 95% CI 1.26-2.72). Complications related to the omentoplasty were reported in 4.6% (95% CI 2.5%-8.6%).CONCLUSIONS: This meta-analysis revealed no beneficial effect of omentoplasty on presacral abscess formation and perineal wound healing after APR, while it increases the likelihood of developing a perineal hernia. These findings do not support the routine use of omentoplasty in APR for cancer.

AB - OBJECTIVE: The objective of this systematic review and meta-analysis was to examine the effects of omentoplasty on pelviperineal morbidity following abdominoperineal resection (APR) in patients with cancer.BACKGROUND: Recent studies have questioned the use of omentoplasty for the prevention of perineal wound complications.METHODS: A systematic review of published literature since 2000 on the use of omentoplasty during APR for cancer was undertaken. The authors were requested to share their source patient data. Meta-analyses were conducted using a random-effects model.RESULTS: Fourteen studies comprising 1894 patients (n = 839 omentoplasty) were included. The majority had APR for rectal cancer (87%). Omentoplasty was not significantly associated with the risk of presacral abscess formation in the overall population (RR 1.11; 95% CI 0.79-1.56), nor in planned subgroup analysis (n = 758) of APR with primary perineal closure for nonlocally advanced rectal cancer (RR 1.06; 95% CI 0.68-1.64). No overall differences were found for complicated perineal wound healing within 30 days (RR 1.30; 95% CI 0.92-1.82), chronic perineal sinus (RR 1.08; 95% CI 0.53-2.20), and pelviperineal complication necessitating reoperation (RR 1.06; 95% CI 0.80-1.42) as well. An increased risk of developing a perineal hernia was found for patients submitted to omentoplasty (RR 1.85; 95% CI 1.26-2.72). Complications related to the omentoplasty were reported in 4.6% (95% CI 2.5%-8.6%).CONCLUSIONS: This meta-analysis revealed no beneficial effect of omentoplasty on presacral abscess formation and perineal wound healing after APR, while it increases the likelihood of developing a perineal hernia. These findings do not support the routine use of omentoplasty in APR for cancer.

U2 - 10.1097/SLA.0000000000003266

DO - 10.1097/SLA.0000000000003266

M3 - Article

C2 - 30921047

SN - 0003-4932

VL - 271

SP - 654

EP - 662

JO - Annals of Surgery

JF - Annals of Surgery

IS - 4

ER -

A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer

Abstract

Research programs

UN SDGs

Access to Document

Fingerprint

Cite this