Hindawi Publishing Corporation International Journal of Surgical Oncology Volume 2012, Article ID 156935, 6 pages doi:10.1155/2012/156935 Clinical Study Abdominoperineal Resection for Rectal Cancer: Is the Pelvic Drain Externalization Site an Independent Risk Factor for Perineal Wound Healing? M. G. Pramateftakis, 1 D. Raptis, 1 D. Kanellos, 2 E. Christoforidis, 1 G. Tsoulfas, 2 I. Kanellos, 1, 2 and Ch. Lazaridis 1 1 4th Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Exochi, 57010 Thessaloniki, Greece 2 Surgical Department, European Medical Center, Pilea, 55236 Thessaloniki, Greece Correspondence should be addressed to D. Raptis, dimitrios.raptis@uk-erlangen.de Received 19 December 2011; Accepted 14 February 2012 Academic Editor: Nikolaos Touroutoglou Copyright © 2012 M. G. Pramateftakis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim. The aim of this paper is to investigate if the insertion of the pelvic drainage tube via the perineal wound could be considered as an independent risk factor for perineal healing disorders, after abdominoperineal resection for rectal malignancy. Patients and Methods. The last two decades, 75 patients underwent elective abdominoperineal resection for malignancy. In 42 patients (56%), the pelvic drain catheter was inserted through the perineal wound (PW group), while in the remaining 33 (44%) through a puncture skin wound of the perineum (SW group). Patients’ data with respect to age (P = 0.136), stage (P> 0.05), sex (P = 0.188) and comorbidity (P = 0.128) were similar in both groups. 25 patients (PW versus SW: 8 versus 17, P = 0.0026) underwent neoadjuvant radio/chemotherapy. Results. The overall morbidity rate was 36%, but a significant increase was revealed in PW group (52.4% versus 9%, P = 0.0007). In 33.3% of the patients in the PW group, perineal healing was delayed, while in the SW group, no delay was noted. Perineal healing disorders were revealed as the main source of increased morbidity in this group. Conclusion. The insertion of the pelvic drain tube through the perineal wound should be considered as an independent risk factor predisposing to perineal healing disorders. 1. Introduction The abdominoperineal resection (APR) was first described by Miles in 1908, but early clinical trials reported operative morbidity rates as high as 40% [1–4]. Nissan et al. [5] reported an overall morbidity rate of 50–60% in patients undergoing APR for carcinoma. After the rectum is excised, the sacral cavity forms a large wound area that cannot be effi- ciently reduced. That area is prone to retention and infection. Besides, it is well documented that postoperative complica- tions of the perineal wound and their long-term residuals comprise the major morbidity factor, especially when com- bined with neoadjuvant radio/chemotherapy [6–8]. According to published data, some authors recommend the pelvic drain externalization through an abdominal stab incision, while others bring out the tubes directly through the perineum—either via a separate skin incision or via the perineal wound [9–11]. With regards to our technique, we believe that a perineal externalization site produces better results due to the gravity. To our knowledge, there are no studies up to date concerning the effects of the pelvic drain externalization site on the morbidity rates. The aim of this study is to investigate whether the inser- tion of the pelvic drainage tube via the perineal wound could be considered as an independent risk factor for perineal healing disorders, following APR for rectal malignancy. 2. Patients and Methods Between 1991 and 2010, elective abdominoperineal resection for rectal carcinoma was performed in 75 patients (47 males