Evaluation of the Efficacy of Negative Pressure Wound Therapy on Perineal Healing Following Abdominoperineal Amputation (AAPICO)

Abdomino-perineal resection is a surgical procedure involving the removal of the rectum and anus via abdominal and perineal approaches. During this procedure, a terminal colostomy is created and the perineum is closed. This procedure is indicated for patients with non-metastatic adenocarcinoma of the lower and very lower rectum (where preservation of the sphincter apparatus is not possible) or squamous cell carcinoma of the anal canal that does not respond to chemoradiotherapy.

Most often, treatment for non-metastatic adenocarcinoma of the lower and very lower rectum is part of a therapeutic sequence that includes neoadjuvant chemoradiotherapy followed by surgery 7 to 12 weeks later. Recently, the GRECCAR group (Rectal Surgery Research Group) published the results of the Prodigy 23 study demonstrating the benefit of intensification chemotherapy prior to neoadjuvant chemoradiotherapy.

This neoadjuvant regimen, and in particular chemoradiotherapy, can lead to impaired postoperative wound healing due to radiation-damaged tissue.

The incidence of impaired wound healing following chemoradiotherapy varies in the literature, with rates ranging from 30% to 70%. These wound complications can lead to local skin infections that may progress to pelvic sepsis, resulting in septic shock.

The perineum can be closed directly with a skin suture, but perineal reconstructions using a musculocutaneous flap have also been described. These reconstruction techniques require more extensive operating room coordination due to the need for a plastic and reconstructive surgery team. For this reason, the use of musculocutaneous flaps is not routine.

In recent years, pharmaceutical companies have developed a negative-pressure wound therapy system that allows for the absorption of infectious material and exudate through the wound. This system is intended to reduce surgical site infections. Results in the literature are inconsistent, with varying indications.

Rather et al. report a nearly 40% improvement in wound healing using a negative pressure therapy system on a closed perineal wound. In the literature review published by Meyer et al. in 2021, positive results of this technique are reported, with a 25% to 30% improvement in wound healing.

These results are encouraging, but currently there are no studies with a high level of evidence analyzing this practice.

For this reason, it is necessary to evaluate negative pressure therapy on perineal scars following chemoradiotherapy and abdominoperineal resection.

Study Overview

• Status: Not yet recruiting
• Conditions: Adenocarcinoma (NOS)
• Intervention / Treatment: Other: Direct perineal skin suture; Device: Direct perineal skin suturing with negative pressure wound therapy (PICO 7®)

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Agnès DORION; Phone Number: +33 2 51 44 63 80; Email: agnes.dorion@ght85.fr

Study Locations

• France
  • Amiens, France, 80054
    • CHU Amiens
    • Principal Investigator: Charles SABBAGH, Dr.
  • Angers, France, 49933
    • CHU Angers
    • Principal Investigator: Aurélien VENARA, Dr.
  • La Roche-sur-Yon, France, 85925
    • CHD Vendee
    • Principal Investigator: Emeric ABET, Dr.
  • Paris, France
    • Hospital Saint Antoine (Aphp)
    • Principal Investigator: Yann PARC, Pr.
  • Rennes, France, 35033
    • Chu Rennes
    • Principal Investigator: Aude MERDRIGNAC, Dr.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adult patient;
• Patient scheduled to undergo abdominoperineal resection for adenocarcinoma of the lower and very lower rectum following chemoradiotherapy (50 Gy over 5 weeks);
• Patients capable of following the clinical trial protocol and who have provided written informed consent to participate in the clinical trial;
• Patients enrolled in the social security system or eligible for coverage;

Exclusion Criteria:

• Patients scheduled to undergo a salvage abdominoperineal resection for squamous cell carcinoma following chemoradiotherapy;
• Patients scheduled to undergo an abdominoperineal resection for adenocarcinoma of the very low rectum without neoadjuvant therapy;
• Patients with a known allergy to the dressing;

• Patients with a contraindication to the use of the PICO 7® dressing:

  • Malignancy within the wound bed or at the wound margins;
  • Previously confirmed, untreated osteomyelitis;
  • Non-enteric, unexplored fistulas;
  • Necrotic tissue with pressure ulcers;
  • Exposed arteries, veins, nerves, or organs;
  • Exposed anastomotic sites;
• Patients participating in another clinical research protocol that could affect the objectives of this clinical trial;
• Patients already randomized in this clinical trial;
• Pregnant patients, women in labor, breastfeeding women, or women of childbearing age not using effective contraception*;
• Patients under guardianship, conservatorship, or deprived of their liberty;
• Patients under an activated future protection order;
• Patients under family authorization;
• Patients under judicial protection.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Sham Comparator: Standard: Direct perineal skin suture;	Other: Direct perineal skin suture; Patients receive a skin suture that is checked daily during their hospital stay to ensure there are no local complications. Dressings are not routinely applied to the skin suture.
Experimental: Experimental: Direct perineal skin suturing with negative pressure wound therapy (PICO 7®)	Device: Direct perineal skin suturing with negative pressure wound therapy (PICO 7®); The PICO 7® single-use negative pressure wound therapy system consists of a pump and two sterile dressings. The PICO 7® pump maintains a negative pressure of 80 mmHg (nominal) at the wound surface. Wound exudate is managed by the dressing through a combination of absorption and evaporation of moisture through the outer film. PICO 7® is designed for use on wounds measuring up to 400 cm³ (surface area x depth), considered to be mildly to moderately exudative, and can be used on sutured surgical wounds. For prophylaxis, the dressing is applied for a period of 14 days, with the dressing and pump replaced on the 7th day.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The occurrence of at least one infectious complication at the perineal incision site within 45 days of the procedure.	The 45-day period was chosen to allow for evaluation of the wound before resuming adjuvant therapy, particularly chemotherapy. To avoid worsening the patient's oncological prognosis, adjuvant therapy must be resumed between 6 and 8 weeks after surgery. A perineal infection will be defined by perineal discharge with a bacteriological culture and the initiation of antibiotic therapy, or the presence of a pelvic collection on an abdominal-perineal CT scan associated with a biological inflammatory syndrome (white blood cell count > 10,000/mm³ and CRP > 5 mg/L).	45-day

Collaborators and Investigators

• Sponsor: Centre Hospitalier Departemental Vendee
• Investigators: Principal Investigator: Emeric ABET, Dr., CHD Vendee

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): June 15, 2029
• Study Completion (Estimated): June 15, 2029

Study Registration Dates

• First Submitted: March 18, 2026
• First Submitted That Met QC Criteria: March 18, 2026
• First Posted (Actual): March 24, 2026

Study Record Updates

• Last Update Posted (Actual): May 22, 2026
• Last Update Submitted That Met QC Criteria: May 20, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: adenocarcinoma; negative pressure wound therapy; abdominal-perineal resection
• Additional Relevant MeSH Terms: Neoplasms; Neoplasms by Histologic Type; Neoplasms, Glandular and Epithelial; Carcinoma; Adenocarcinoma; Therapeutics; Surgical Procedures, Operative; Drainage; Wound Closure Techniques; Negative-Pressure Wound Therapy
• Other Study ID Numbers: CHD24_0008

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No