Santos David A, Zhang Liangliang, Do Kim-Anh, Bednarski Brian K, Robinson Ledet Celia, Limmer Angela, Gibson Heather, You Y Nancy
Department of Surgical Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Biostatistics, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Am Surg. 2023 Jan;89(1):98-107. doi: 10.1177/00031348211011149. Epub 2021 Apr 20.
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.
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.
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 < .05). Adjuvant chemotherapy (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.18-2.31, < .01), age (HR .99, 95% CI .97-1.00, < .01), body mass index (HR 1.02, 95% CI 1.00-1.04, < .01), and neoadjuvant chemotherapy (HR 1.92, 95% CI 1.21-3.00, < .01) were independently associated with PVIH. Postoperative ventral incisional hernia was more common overall in patients who received adjuvant chemotherapy (46% compared with 30%, < .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.
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.
化疗与结肠癌右半结肠切除术（RHC）术后腹直肌切口疝（PVIH）相关，腹壁关闭技术可能影响PVIH。我们试图确定PVIH的临床预测因素。
我们回顾性分析了2008年至2018年接受RHC治疗结肠癌且随后发生PVIH的患者。采用Kaplan-Meier分析对PVIH发生时间进行分析，通过多变量Cox比例风险模型确定临床预测因素，并采用贝叶斯分析估计化疗和缝合技术情况下PVIH的概率。
我们确定了399例患者（209例未接受辅助化疗，190例接受辅助化疗），总体PVIH发生率为38%。辅助化疗患者的5年PVIH发生率为55%，未接受辅助化疗患者为38%（对数秩检验P<0.05）。辅助化疗（风险比[HR]1.65，95%置信区间[CI]1.18 - 2.31，P<0.01）、年龄（HR 0.99，95%CI 0.97 - 1.00，P<0.01）、体重指数（HR 1.02，95%CI 1.00 - 1.04，P<0.01）和新辅助化疗（HR 1.92，95%CI 1.21 - 3.00，P<0.01）与PVIH独立相关。总体而言，接受辅助化疗的患者术后腹直肌切口疝更常见（46%对比30%，P<0.01）。在接受辅助化疗的患者中，使用1号连续环形聚二氧六环酮缝合切口关闭时PVIH的概率为42%，而使用0号单间断聚乙醇酸910缝合切口关闭时为59%。
接受化疗会增加RHC术后发生PVIH的概率，非短缝合切口关闭会进一步增加这种概率，比年龄或体重指数的影响更大。作为这个高风险人群中的一个可改变因素，缝合技术值得进一步研究。
