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Comparison of Tumor Recurrence in Oncoplastic Pelvic Reconstruction with VRAM versus Omental Flaps: A Recurrence-Free Survival Analysis
Jeremie D. Oliver, BA1, Arif Chaudhry, MD2, Krishna S. Vyas, MD, PhD, MHS2, Nho V. Tran, MD2, Jorys Martinez-Jorge, MD2, David Larson, MD2, Eric Dozois, MD2, Heidi Nelson, MD2, Oscar J. Manrique, MD2.
1Mayo Clinic School of Medicine, Rochester, MN, USA, 2Mayo Clinic, Rochester, MN, USA.

BACKGROUND: The purpose of this study is to describe our experience and outcomes in oncoplastic pelvic reconstruction for patients who underwent either vertical rectus abdominis musculocutaneous (VRAM) or omental flap following abdominoperineal resection (APR) at a single tertiary care institution.
METHODS: All patients who underwent pelvic reconstruction following APR with either VRAM or omental flaps from January 1992 - January 2017 were retrospectively reviewed. Patient demographics and relevant comorbidities including chemotherapy and radiation therapy data were collected and analyzed. In addition, margin status at the time of oncologic resection was analyzed. Flap-specific data were collected for each approach. Oncologic data collected includes cancer type, stage at time of APR, and rate of tumor recurrence within the flap.
RESULTS: A total of 562 patients were identified who underwent pelvic reconstruction with either VRAM or omental pedicle flaps. Of these, 274 (48.8%) underwent VRAM reconstruction and 288 (51.2%) underwent omental flap reconstruction. All margins were negative at time of cancer ablation surgery. Complications data included: seroma [VRAM=2(0.36%); Omentum=32(5.69%), p<0.0001], wound dehiscence [VRAM=31(5.52%); Omentum=17(3.02%), p=0.022], abscess [VRAM=4(0.71%); Omentum=27(4.8%), p<0.0001], cellulitis [VRAM=2(0.36%); Omentum=10(1.78%), p=0.025]. Statistical comparison of tumor recurrence between these two reconstructive approaches showed a significantly higher recurrence rate in omental flaps compared to VRAM flaps (p= 0.000127).
CONCLUSIONS: The results of this study suggest a significantly higher tumor recurrence rate in omental flap pelvic reconstruction compared to VRAM flaps. This knowledge has the potential to influence surgical planning and flap selection in pelvic reconstruction.

Table 2. Complications Analysis - VRAM vs Omentum Flaps
VRAM (n=274)Omentum (n=288)p-value (Pearson's Exact Test)
Hematoma1 (0.18%)6 (1.07%)0.0664
Seroma2 (0.36%)32 (5.69%)*<0.0001
Bowel Obstruction02 (0.36%)0.167
Wound Dehiscence31 (5.52%)17 (3.02%)*0.0218
Abscess4 (0.71%)27 (4.8%)*<0.0001
Local Wound Infection9 (1.6%)7 (1.25%)0.5428
Abdominal Hernia10 (1.78%)14 (2.49%)0.4777
Abdominal Bulge6 (1.07%)12 (2.14%)0.1834
Cellulitis2 (0.36%)10 (1.78%)*0.0246

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