Preoperative Radiotherapy as a Major Risk Factor for Pelvic Abscess after Abdominoperineal Resection and Total Pelvic Exenteration: A Retrospective Study

Abstract

Objectives: Pelvic abscess, alongside perineal wound infection, is a major postoperative complication after abdominoperineal resection (APR) and total pelvic exenteration (TPE). Because the underlying mechanisms of these two complications differ, separate evaluation is warranted. This study aimed to identify risk factors specifically associated with pelvic abscess.

Methods: We retrospectively analyzed patients who underwent APR or TPE at our institution between December 2004 and August 2025. Patients were divided into abscess and non-abscess groups, and patient characteristics and surgical variables were compared using univariate and multivariate analyses.

Results: Among 215 patients, 187 (87%) underwent APR and 28 (13.0%) underwent TPE. The incidence of pelvic abscess was 18.1% (39/215). Univariate analysis identified significantly higher abscess rates in patients receiving preoperative radiotherapy (28.2% vs. 8.5%, p = 0.002) and in those with greater blood loss (894.0 vs. 390.0 mL, p = 0.015). Multivariate analysis confirmed preoperative radiotherapy as an independent predictor (p = 0.002). No difference in pelvic abscess incidence was found among patients who underwent APR with or without combined resection of adjacent pelvic organs.

Conclusion: Preoperative radiotherapy is a significant risk factor for pelvic abscess after APR and TPE. Future studies should refine preventive strategies and develop targeted approaches for high-risk patients.