Gluteal Flap Reduces Costs After APR : BJS Open | Jun 2026

Introduction:

Perineal wound complications remain a major source of morbidity after abdominoperineal resection (APR) for rectal cancer. Delayed wound healing can result in prolonged outpatient care, increased healthcare utilization, impaired quality of life, and higher overall treatment costs. The gluteal turnover flap has been proposed as a reconstructive technique to improve perineal healing, but its economic value has not been fully established.

Problem Statement:

While surgical innovations may improve clinical outcomes, their adoption increasingly depends on demonstrating cost-effectiveness. It remains unclear whether the additional operative effort required for gluteal turnover flap reconstruction translates into meaningful reductions in healthcare costs and patient burden compared with conventional primary closure.

Summary:

This cost-effectiveness analysis of the multicenter BIOPEX-2 randomized trial evaluated gluteal turnover flap closure versus primary perineal closure following APR for rectal cancer. The study demonstrated that gluteal turnover flap reconstruction was associated with significantly lower overall healthcare costs during follow-up. Cost savings were primarily driven by reductions in outpatient care requirements, specialized wound management, and home healthcare utilization, reflecting improved wound-related outcomes. Although patients who developed perineal wound complications reported substantially poorer health-related quality of life, overall quality-of-life measures were similar between the randomized groups. This likely reflects the lower frequency of wound complications among patients undergoing flap reconstruction. Importantly, the gluteal turnover flap achieved these economic benefits without compromising patient-reported outcomes. The findings suggest that preventing wound complications not only improves clinical recovery but also reduces downstream healthcare expenditure. From both a patient and healthcare system perspective, the gluteal turnover flap represents a high-value intervention that can lessen the burden of postoperative wound care after APR. Overall, this randomized trial provides strong evidence that gluteal turnover flap closure is a cost-saving strategy and supports its broader implementation as a preferred approach for perineal wound reconstruction in appropriately selected rectal cancer patients undergoing APR.