Evaluating negative-pressure wound therapy after abdominoperineal resection: a systematic review of efficacy and technical variability.

Background: Perineal wound complications after abdominoperineal resection (APR) for anal or low rectal cancer remain a significant clinical concern, frequently leading to surgical site infections (SSIs), wound dehiscence, and delayed healing. These complications contribute to increased patient morbidity, prolonged hospitalization, and higher healthcare costs. Prophylactic negative pressure wound therapy (pNPWT) has been proposed to improve wound outcomes in this context, but evidence regarding its effectiveness remains inconclusive.

Objective: This systematic review evaluates the clinical outcomes and technical application of pNPWT in closed perineal wounds following APR, with a focus on its potential impact on SSIs, wound dehiscence, and healing time.

Methods: A systematic literature search was conducted in MEDLINE, Embase, and the Cochrane Library in accordance with PRISMA guidelines. Eligible studies included randomized controlled trials and observational studies assessing pNPWT after APR. Key outcomes of interest were SSI rates, wound dehiscence, healing time, and length of hospital stay. Due to clinical and methodological heterogeneity, a narrative synthesis was performed.

Results: In total, eight studies met the inclusion criteria. The results were heterogeneous: while three studies reported reduced SSI rates with pNPWT compared with conventional wound management, two studies observed higher SSI rates in the pNPWT groups. Variability in device type (canister-based versus portable systems), negative pressure settings, application duration, and patient selection limited the comparability across studies. The risk of bias was moderate to high in several studies, and outcome reporting was inconsistent.

Conclusions: Current evidence does not allow for definitive conclusions regarding the clinical benefit of pNPWT after APR. While some studies suggest potential advantages, particularly in terms of SSI reduction, results remain inconsistent and device-dependent. Further high-quality randomized trials are required to clarify the role of pNPWT and to define optimal application protocols in this challenging surgical context.