{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T07:51:10Z","timestamp":1764316270413,"version":"3.46.0"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To determine whether high complexity pelvic exenterations alter perineal wound morbidity and to assess risk factors for perineal flap complications following complex rectal cancer surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of consecutive adults undergoing complex rectal cancer resections with immediate gluteal flap perineal reconstruction between January 2013\u2010July 2021 at a tertiary referral centre. Conventional complex cancer resections were compared with \u201chigh complexity\u201d exenterations, including en bloc sacrectomy and extended lateral pelvic side wall excision. Primary outcomes were short\u2010term (wound infection, necrosis, dehiscence) and long\u2010term (sinus, fistula, hernia) perineal flap complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 194 patients (median 56 years, 60% male) with gluteal flap reconstructions; 163 (84%) for advanced or recurrent rectal cancer. Gluteal artery perforator flaps were predominantly used (176, 92%). Wound infections were more common in the conventional group (23.2% vs. 6.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), but no other differences in complications were observed between groups. Obesity (HR 2.70, 95% CI 1.22\u20135.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014) and total pelvic exenteration (HR 2.13, 95% CI 1.07\u20134.23,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031) were associated with short\u2010term complications. Age over 65 years predicted readmission\/reoperation (HR 2.66, 95%CI 1.07\u20136.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040). Ureteric\/ileal conduit leaks were associated with long\u2010term complications (HR 3.37, 95% CI 1.21\u20139.34,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024). No flap losses occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Gluteal fasciocutaneous perforator flaps provide reliable perineal reconstruction after complex rectal cancer surgery. The extent of surgery and resulting defect size did not significantly influence perineal wound complication rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70113","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T11:25:35Z","timestamp":1762341935000},"page":"1399-1406","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gluteal Flap Reconstruction Following Complex Rectal Cancer Surgery: A Large Consecutive Series of Perineal Wounds Exploring Risk Factors for Complications"],"prefix":"10.1002","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8014-3762","authenticated-orcid":false,"given":"Laura E.","family":"Gould","sequence":"first","affiliation":[{"name":"Complex Cancer Clinic St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"St Mark\u2032s Academic Institute St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"School of Cancer Sciences, College of Medical, Veterinary &amp; Life Sciences University of Glasgow Glasgow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6142-9762","authenticated-orcid":false,"given":"Edward. T.","family":"Pring","sequence":"additional","affiliation":[{"name":"Complex Cancer Clinic St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"St Mark\u2032s Academic Institute St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"Department of Surgery and Cancer Imperial College London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1621-0323","authenticated-orcid":false,"given":"Ioanna","family":"Drami","sequence":"additional","affiliation":[{"name":"Complex Cancer Clinic St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"St Mark\u2032s Academic Institute St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"Department of Surgery and Cancer Imperial College London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joannis","family":"Constantinides","sequence":"additional","affiliation":[{"name":"Complex Cancer Clinic St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Hodges","sequence":"additional","affiliation":[{"name":"Complex Cancer Clinic St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"St Mark\u2032s Academic Institute St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"Department of Surgery and Cancer Imperial College London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8518-1223","authenticated-orcid":false,"given":"Colin W.","family":"Steele","sequence":"additional","affiliation":[{"name":"School of Cancer Sciences, College of Medical, Veterinary &amp; Life Sciences University of Glasgow Glasgow UK"},{"name":"University Department of Surgery Glasgow Royal Infirmary Glasgow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2649-6695","authenticated-orcid":false,"given":"Campbell S.D.","family":"Roxburgh","sequence":"additional","affiliation":[{"name":"School of Cancer Sciences, College of Medical, Veterinary &amp; Life Sciences University of Glasgow Glasgow UK"},{"name":"University Department of Surgery Glasgow Royal Infirmary Glasgow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0070-6332","authenticated-orcid":false,"given":"Elaine M.","family":"Burns","sequence":"additional","affiliation":[{"name":"Complex Cancer Clinic St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"St Mark\u2032s Academic Institute St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8723-9409","authenticated-orcid":false,"given":"John T.","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Complex Cancer Clinic St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"St Mark\u2032s Academic Institute St Mark\u2032s\u2010The National Bowel Hospital Harrow London UK"},{"name":"School of Cancer Sciences, College of Medical, Veterinary &amp; Life Sciences University of Glasgow Glasgow UK"},{"name":"Department of Surgery and Cancer Imperial College London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs5.50153"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10734"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002528"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318283a5b6"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2013.95.8.539"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000007976"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002107"},{"key":"e_1_2_8_9_1","first-page":"40","article-title":"Decisional Algorithms for the Reconstruction of Pelviperineal Defects After Total Pelvic Exenteration: A Review","volume":"122","author":"Moraru D. 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J.","year":"2023","journal-title":"Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.7822"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16152"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000639"},{"key":"e_1_2_8_19_1","first-page":"38","article-title":"Reconstructive Options Following Abdominoperineal Resection for Anorectal Malignancies: A Literature Review","volume":"21","author":"Bouman H.","year":"2023","journal-title":"World Journal of Surgical Oncology"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182a97ea2"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-014-1967-y"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0827-1"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0855-x"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3450-0"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.14471"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000001137"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001632"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181904df7"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70113","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T07:47:16Z","timestamp":1764316036000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,5]]},"references-count":27,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/jso.70113"],"URL":"https:\/\/doi.org\/10.1002\/jso.70113","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"type":"print","value":"0022-4790"},{"type":"electronic","value":"1096-9098"}],"subject":[],"published":{"date-parts":[[2025,11,5]]},"assertion":[{"value":"2025-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}