The effectiveness of VAC system for pelvic infection in lower rectal cancer patients who underwent abdominoperineal resection after multidisciplinary treatment

【Background】We have provided preoperative chemoradiotherapy(CRT) or total neoadjuvant therapy(TNT) for lower rectal cancer(LRC) patients in order to reduce local recurrence and to increase opportunity for sphincter preserving operation. However, some patients require abdominoperineal resection(APR) to secure tumor margin. Pelvic surgical site infection(pSSI) is one of main issues to overcome after APR. In this study, we investigated the effectiveness of negative pressure wound therapy(NPWT) including vacuum assisted closure(VAC) system to minimize pSSI.【Method】This study includes LRC patients who were performed APR after CRT/TNT from January 2015 to January 2025(n=35). We investigated association between clinicopathological or surgical parameters and pSSI.【Results】In the total cohort consisting of 22 males and 13 females, we used VAC system for 24 patients, and other NPWT or none for 11 patients. The frequency of Grade3(G3) pSSI was 22.9%(n=8). Regarding the association between G3 pSSI and wound management, VAC patients showed significantly lower G3 pSSI (p=0.036). Furthermore, logistic regression univariate analysis showed that non VAC patients were identified as significant risk factor for G3 pSSI (Odds ratio; 5.83, 95%C.I.; 1.12－36.07, p=0.036).【Conclusion】Our study indicates that VAC system might be useful to reduce severe pSSI in LRC patients after multidisciplinary treatment.