SRS378 - Flap <i>versus</i> primary wound closure of perineal defect after abdominoperineal resection (APER) for colorectal cancer: a systematic review and Meta-Analysis

Abstract Aims To evaluate whether primary closure or flap reconstruction provides superior outcomes in patients undergoing abdominoperineal resection (APER) for colorectal cancer. Methods English-language studies published from 1946 to March 2025 were included. The search strategy covered Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews (CDSR). Randomized controlled trials, observational studies, and case series comparing outcomes of primary closure versus flap reconstruction following APER for colorectal carcinoma were eligible for inclusion. Results Data for 4170 patients were analysed, of whom 3598 underwent primary closure and 572 received flap reconstruction. There was no significant difference in perineal wound infection (RR [95% c.i.] 1.24 [0.82–1.89], P = 0.31; I² = 19%), wound dehiscence (RR [95% c.i.] 0.81 [0.47–1.39], P = 0.44; I² = 66%), pelvic collection (RR [95% c.i.] 1.62 [0.62–4.23], P = 0.32; I² = 60%), or perineal fistula (RR [95% c.i.] 0.92 [0.31–2.73], P = 0.88; I² = 10%). Similarly, no differences were found in return to the operating room (RR [95% c.i.] 0.84 [0.47–1.52], P = 0.57; I² = 73%), or mortality (RR [95% c.i.] 1.88 [0.56–6.26], P = 0.30; I² = 0%). Conclusions Flap reconstruction following APER did not demonstrate superiority over primary closure with respect to perineal wound complications, return to OR, readmission, or mortality. These findings suggest that both techniques yield comparable outcomes. Further prospective randomised studies are needed to guide surgical decision-making and standardize practice.