Chemotherapy and patient co-morbidity in ventral site hernia development

Abstract

Objective:The risk factors associated with early ventral site hernia development following cancer surgery are ill defined and associated with an undetermined incidence. Methods: We analyzed 1,391 gynecologic cancer patient charts to identify the number of post-operative ventral site hernias over a nearly 6 year period. The following study variables were noted for evaluation: patient demographics, disease co-morbidity (hypertension, cardiovascular disease, diabetes), body mass index (BMI), treatment (e.g., chemotherapy regimen), intra-operative (e.g., bleeding) and postoperative (e.g., infection) complications, time to hernia development and length of hospital stay. Results: Twenty-six gynecologic cancer patients who developed a post-operative ventral hernia and subsequently underwent herniorrhaphy by our gynecologic oncology service were identified. The patient group's overall time to initial hernia development was 11.23 months. Following a multiple regression analysis, we found that treatment (e.g., bevacizumab, liposomal doxorubicin or radiotherapy associated with compromised wound healing [p=0.0186] and disease co-morbidity [0.0432]) were significant prognostic indicators for an accelerated time to hernia development. Moreover, five patients underwent treatment associated with compromised wound healing and also had disease co-morbidity. In this sub-group, post-operative hernia development occurred more rapidly (3.8 months) than the overall group of patients. BMI and age did not impact time to hernia development (p＞0.05). Conclusion:In the present gynecologic cancer patient series, a tendency for early post-operative hernia development appeared to coincide with treatment associated with compromised wound healing and disease co-morbidity. Gynecologic cancer surgeons should anticipate this potential complication and consider employing prophylactic intra-operative mesh to potentially prevent this condition.

Is laparoscopic treatment of incisional and recurrent hernias associated with an increased risk for complications?

“…Interestingly, most patients underwent chemotherapy because of underlying malignancy in all three sub-groups of patients (primary hernia 83.3%, incisional hernia 82.1%, recurrent hernia 81.8%). Both, underlying malignancy and chemotherapy are known risk factors in hernia development [9,12]. Obesity is one of the most important factors in hernia development [13].…”

Incisional hernia and its impact on health-related quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a national prospective cohort study

“…Additionally, smoking and use of preoperative steroids and cytostatic drugs/chemotherapy have been suggested to increase the risk of IHs [ 12 ]. This causality has been suggested to be due to its association with a delayed healing process of the abdominal wound [ 13 ].…”

Chemotherapy does not adversely impact outcome following post‐incisional hernia repair with biomaterial mesh

“…The mean number of previous abdominal operations was two (range [1][2][3][4][5]. The mean defect size in the NCT group was 8 cm (range [3][4][5][6][7][8][9][10][11] and in the CT group it was 9 cm (range 4-12) with no statistically significant difference between the groups. In the NCT group, 6 (21%) patients presented with incarcerated hernia, compared with 5 (29%) patients in the CT group (P ¼ 0.54).…”