Inadvertent perforation of the rectum during abdominoperineal resection

Intraoperative inadvertent perforation of the rectum is a potentially avoidable complication of abdominoperineal resection (APR). Although widely thought to be detrimental, the impact of inadvertent perforation on outcome has not been conclusively determined, especially after controlling for potential confounding variables. The objective of this study was to determine if inadvertent perforation of the rectum during APR for rectal cancer is an independent risk factor for the adverse outcomes of local recurrence and/or death. This retrospective cohort study included all patients who underwent APR for primary adenocarcinoma of the rectum at a single teaching hospital from 1980 to 1990. Data were obtained regarding patient demographics, presence of inadvertent perforation, histopathological characteristics, adjuvant therapy, local recurrence, and survival. Of 178 patients included in the study, 42 (24%) had inadvertent perforation. By univariate analysis, local recurrence was significantly higher in the perforated group than the nonper-forated group (54% vs 17%; P