Incidence of incisional hernia after major colorectal cancer surgery &amp; analysis of associated risk factors in Asian population: Is laparoscopy any better?

Khor, Shao Nan; Cheok, Sabrina Hui Xian; Sultana, Rehena; Tan, Emile

doi:10.1016/j.asjsur.2022.01.029

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…TNM classification is currently considered the most prognostic factor [37]. Clinical information regarding tumor characteristics was not available for analysis in this study, although post-surgical complications, including perforation, stoma-related obstruction [38], incisional hernia [39], or enhanced recovery care [40], were related to emergency indications and long-term prognosis. Further epidemiological research should qualify comprehensive prognosis after CRC surgery, including robot-assisted laparoscopy, which was not included in Japanese insurance [3,4].…”

Section: Discussionmentioning

confidence: 98%

Longitudinal analysis of long-term outcomes of colorectal cancer after laparotomy and laparoscopic surgery: The Shizuoka study

Kojimahara,

Sato,

Sato

et al. 2023

PLoS ONE

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Background Long-term cancer prognosis after initial surgical procedures is an unlikely endpoint for clinical trials. Medical claim databases may aid in addressing this issue regardless of limited information on disease and patient background. However, the long-term prognosis (especially regarding long-term care needs) following surgical procedures remains unclear. This study aimed to assess whether long-term outcomes, such as the exacerbation of long-term care needs and mortality, differ with surgical methods. Methods Using a longitudinal study with linkage between medical claim and long-term care database, patients with primary colorectal cancer who underwent initial colonoscopies were identified through anonymized data in Japan (Shizuoka Kokuho Database, 2012–2018). Odds ratios (ORs) for long-term outcomes (long-term care needs and all-cause mortality during a 6.5-year follow-up period) were analyzed using logistic regression to compare laparoscopy and endoscopic surgery to laparotomy. Results Overall, 3,744 primary colorectal cancer cases (822 laparotomies, 705 laparoscopies, and 2,217 endoscopic surgeries) were included. Compared to the laparotomy group, the crude OR for exacerbation of long-term care needs in the laparoscopic surgery group was 0.376 (95% confidence interval, 0.227, 0.624), while the OR for all-cause mortality was 0.22 (0.329, 0.532). Conclusion This is the first study to analyze long-term prognosis after surgery for patients with colorectal cancer to combine medical and long-term needs data. As the national health insurance claim database rarely includes information on cancer stage and comorbidities, better prognosis on endoscopic surgery may need careful interpretation. Therefore, laparoscopy has superior outcomes in terms of long-term care needs and mortality compared to those of laparotomy.

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Section: Discussionmentioning

confidence: 98%

Longitudinal analysis of long-term outcomes of colorectal cancer after laparotomy and laparoscopic surgery: The Shizuoka study

Kojimahara,

Sato,

Sato

et al. 2023

PLoS ONE

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Section: Introductionmentioning

confidence: 99%

“…In one study, the incidence rates of incisional hernia in patients undergoing laparoscopic versus open colorectal cancer surgery were 12.3% versus 13.8%, respectively. 5 In addition, because the length of the abdominal incision is directly related to the incisional hernia rate, avoiding laparotomy might influence the rate of postoperative wound complications. 6 The development of natural orifice transluminal endoscopic surgery (NOTES) has provided the notable advantages of completely avoiding surgical wounds and wound-related postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic natural orifice specimen extraction, a minimally invasive surgical technique for mid-rectal cancers: Retrospective single-center analysis and single-surgeon experience of selected patients

et al. 2022

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Objective To evaluate the feasibility, safety, and short-term outcomes of middle rectal resection followed by transanal specimen extraction. Methods Forty-four patients with small mid-rectal tumors underwent laparoscopic rectal resection followed by transanal specimen extraction. Results The procedure was successful in all patients without intraoperative conversion or additional access. The mean operation time was 182.7 minutes (range, 130–255 minutes), the mean blood loss was 26.5 mL (range, 5–120 mL), the mean postoperative exhaust time was 31.3 hours (range, 16–60 hours), and the mean length of hospital stay was 9.5 days (range, 8–19 days). One patient developed anastomotic leakage, which was treated by intravenous antibiotics and daily pelvic cavity flushes through the abdominal drainage tube. No infection-related complications or anal incontinence were observed. The mean tumor size was 2.1 cm (range, 1.6–3.2 cm), the mean number of harvested lymph nodes was 16.5 (range, 6–31), and the mean follow-up time was 8.5 months (range, 2–16 months). By the last follow-up, no signs of recurrence had been found in any patient. Conclusion The combination of standard laparoscopic proctectomy and transanal specimen extraction could become a well-established strategy for selected patients.

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“…Minimally invasive techniques have revolutionized the field of surgery with benefits that include reduced postoperative pain, earlier return to normal activities, and fewer postoperative complications compared to open techniques [ 1 ]. Despite the increased application of minimally invasive surgery, incisional hernias remain a common complication in surgery with incidences of 6–12% [ 2 , 3 ]. Pain, discomfort, and reduced quality of life (QoL) are the main symptoms in 78–85% of patients undergoing incisional hernia repairs [ 4 – 6 ].…”

mentioning

confidence: 99%

The INCH-trial: a multicenter randomized controlled trial comparing short- and long-term outcomes of open and laparoscopic surgery for incisional hernia repair

van Veenendaal,

Poelman,

Apers

et al. 2023

Surg Endosc

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Background Laparoscopic incisional hernia repair is increasingly performed worldwide and expected to be superior to conventional open repair regarding hospital stay and quality of life (QoL). The INCisional Hernia-Trial was designed to test this hypothesis. Methods A multicenter parallel randomized controlled open-label trial with a superiority design was conducted in six hospitals in the Netherlands. Patients with primary or recurrent incisional hernias were randomized by computer-guided block-randomization to undergo either conventional open or laparoscopic repair. Primary endpoint was postoperative length of hospital stay in days. Secondary endpoints included QoL, complications, and recurrences. Patients were followed up for at least 5 years. Results Hundred-and-two patients were recruited and randomized. In total, 88 patients underwent surgery and were included in the intention-to-treat analysis (44 in the open group, 44 in the laparoscopic group). Mean age was 59.5 years, gender division was equal, and BMI was 28.8 kg/m. The trial was concluded early for futility after an unplanned interim analysis, which showed that the hypothesis needed to be rejected. There was no difference in primary outcome: length of hospital stay was 3 (range 1–36) days in the open group and 3 (range 1–12) days in the laparoscopic group (p = 0.481). There were no significant between-group differences in QoL questionnaires on the short and long term. Satisfaction was impaired in the open group. Overall recurrence rate was 19%, of which 16% in the open and 23% in the laparoscopic group (p = 0.25) at a mean follow-up of 6.6 years. Conclusions In a randomized controlled trial, short- and long-term outcomes after laparoscopic incisional hernia repair were not superior to open surgery. The persisting high recurrence rates, reduced QoL, and suboptimal satisfaction warrant the need for patient’s expectation management in the preoperative process and individualized surgical management. Trial registration Netherlands Trial Register NTR2808.

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Incidence of incisional hernia after major colorectal cancer surgery & analysis of associated risk factors in Asian population: Is laparoscopy any better?

Cited by 6 publications

References 29 publications

Longitudinal analysis of long-term outcomes of colorectal cancer after laparotomy and laparoscopic surgery: The Shizuoka study

Longitudinal analysis of long-term outcomes of colorectal cancer after laparotomy and laparoscopic surgery: The Shizuoka study

Laparoscopic natural orifice specimen extraction, a minimally invasive surgical technique for mid-rectal cancers: Retrospective single-center analysis and single-surgeon experience of selected patients

The INCH-trial: a multicenter randomized controlled trial comparing short- and long-term outcomes of open and laparoscopic surgery for incisional hernia repair

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