Chemotherapy and Abdominal Wall Closure Technique Increase the Probability of Postoperative Ventral Incisional Hernia in Patients With Colon Cancer

Abstract

Background Chemotherapy is associated with postoperative ventral incisional hernia (PVIH) after right hemicolectomy (RHC) for colon cancer, and abdominal wall closure technique may affect PVIH. We sought to identify clinical predictors of PVIH. Methods We retrospectively analyzed patients who underwent RHC for colon cancer from 2008-2018 and later developed PVIH. Time to PVIH was analyzed with Kaplan-Meier analysis, clinical predictors were identified with multivariable Cox proportional hazards modeling, and the probability of PVIH given chemotherapy and the suture technique was estimated with Bayesian analysis. Results We identified 399 patients (209 no adjuvant chemotherapy and 190 adjuvant chemotherapy), with an overall PVIH rate of 38%. The 5-year PVIH rate was 55% for adjuvant chemotherapy, compared with 38% for none (log-rank P < .05). Adjuvant chemotherapy (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.18-2.31, P < .01), age (HR .99, 95% CI .97-1.00, P < .01), body mass index (HR 1.02, 95% CI 1.00-1.04, P < .01), and neoadjuvant chemotherapy (HR 1.92, 95% CI 1.21-3.00, P < .01) were independently associated with PVIH. Postoperative ventral incisional hernia was more common overall in patients who received adjuvant chemotherapy (46% compared with 30%, P < .01). In patients who received adjuvant chemotherapy, the probability of PVIH for incision closure with #1 running looped polydioxanone was 42%, compared with 59% for incision closure with #0 single interrupted polyglactin 910. Discussion Exposure to chemotherapy increases the probability of PVIH after RHC, and non–short stitch incision closure further increases this probability, more so than age or body mass index. The suture technique deserves further study as a modifiable factor in this high-risk population.

Retrospective study of an incisional hernia after laparoscopic colectomy for colorectal cancer

“…Fifthly, this study data was not collected the details of postoperative adjuvant chemotherapy. The adjuvant chemotherapy for colon cancer was recently associated with a high incidence of IH [ 29 ], however, many prospective randomized studies evaluating the effect of adjuvant chemotherapy were conducted, and none reported an increased risk of IH by any regimen of chemotherapy [ 30 – 32 ]. So, this study did not analyze the influence of chemotherapy.…”

Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery

“…Additionally, factors such as smoking, traumatic complications[ 30 ], adjuvant chemotherapy for colon cancer[ 31 ], postoperative weight gain[ 32 ], elevated intra-abdominal pressure, and prior abdominal surgeries[ 33 ] are also associated with a higher incidence of IH.…”

“…Studies have demonstrated that the use of monofilament sutures can reduce the incidence of IH[ 47 ]. Partial fascial closure techniques may increase the risk of postoperative abdominal wall hernia[ 31 ]. Hughes abdominal closure experiments have initially shown promise in reducing the risk of IH[ 48 , 49 ], but further clinical validation is still required[ 50 ].…”