Prevention and treatment of pelvic complications after rectal cancer surgery

This thesis aims to discuss the potential contribution of changes in pelvic anatomy to surgical morbidity, as well as the prevention and treatment of pelvic complications after rectal cancer surgery.
The first part focuses on the evaluation of complications using pelvic imaging. We found substantial displacement of urogenital organs after abdominoperineal resection (APR). We could not demonstrate a correlation between urogenital organ displacement and urinary function, but there seemed to be a correlation with sexual function in women.
The second part discusses different primary reconstructive techniques and the effect on perineal morbidity. We found that even a sufficient omentoplasty, as determined by postoperative imaging, does not reduce pelvic complications after APR for rectal cancer. The prophylactic use of a biological mesh lowered the incidence of perineal hernia, however no improvement in perineal wound healing was found. A new technique was introduced to improve perineal wound healing after APR, named the gluteal turnover flap. The flap appears to be promising and is currently being investigated in the BIOPEX-2 study. This randomised controlled trial compares primary closure with gluteal turnover flap after APR for rectal cancer.
The third part focuses on secondary surgical management for long-term sequelae. We found that high rates of success can be achieved with surgical salvage of pelvic sepsis in a dedicated tertiary referral center. Recurrence rates after mesh repair of perineal hernia are high, without clear difference between biological and synthetic meshes. The addition of a tissue flap to mesh repair seemed to have a favorable outcome.