Cho Sung Chun, Eom Bang Wool, Yoon Hong Man, Kim Young-Woo, Ryu Keun Won
Department of Surgery, National Cancer Center, Goyang, Korea.
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
J Minim Invasive Surg. 2021 Jun 15;24(2):84-90. doi: 10.7602/jmis.2021.24.2.84.
Although there are several studies on the incidence and risk factors for incisional hernia (IH) after open surgery, data about IH after minimally invasive surgery (MIS) for gastric cancer is rare. This study aimed to identify the incidence and risk factors for IH after MIS in gastric cancer patients.
We analyzed the clinicopathologic data of patients who had laparoscopic or robotic gastric cancer surgeries between January 2006 and July 2019 at National Cancer Center, South Korea. Risk factors for development of IH were investigated with univariate and multivariate analyses.
A total of 2,769 patients underwent laparoscopic-assisted or robot-assisted gastrectomy with extracorporeal gastric resection and reconstruction, while 1,469 underwent totally laparoscopic or totally robotic gastrectomy (TLRG) with intracorporeal gastric resection and reconstruction. IH repair was performed in 23 patients (0.5%) after gastric cancer surgery. In the multivariate analysis, female sex (odds ratio [OR], 5.23; 95% confidence interval [CI], 2.03-13.43; = 0.001), high body mass index (BMI) of ≥25 kg/m (OR, 4.23; 95% CI, 1.73-10.35; = 0.002), larger tumor size (OR, 21.67; 95% CI, 5.37-87.34; < 0.001), and intracorporeal procedure (OR, 5.63; 95% CI, 2.15-14.61; < 0.001) were independent significant risk factors for IH.
IH after MIS for gastric cancer is not common. Female sex, high BMI, large tumor size, and intracorporeal procedure were significant risk factors for it in this study. Therefore, in patients with risk factors, surgeons should cautiously close the abdominal wall access wound after MIS for gastric cancer, to prevent IH.
尽管有多项关于开放手术后切口疝（IH）发生率及危险因素的研究，但关于胃癌微创手术（MIS）后IH的数据却很少。本研究旨在确定胃癌患者MIS后IH的发生率及危险因素。
我们分析了2006年1月至2019年7月在韩国国立癌症中心接受腹腔镜或机器人胃癌手术患者的临床病理数据。通过单因素和多因素分析研究IH发生的危险因素。
共有2769例患者接受了腹腔镜辅助或机器人辅助胃切除术并进行体外胃切除和重建，而1469例患者接受了全腹腔镜或全机器人胃切除术（TLRG）并进行体内胃切除和重建。23例（0.5%）患者在胃癌手术后进行了IH修复。多因素分析显示，女性（比值比[OR]，5.23；95%置信区间[CI]，2.03 - 13.43；P = 0.001）、体重指数（BMI）≥25 kg/m²（OR，4.23；95% CI，1.73 - 10.35；P = 0.002）、肿瘤体积较大（OR，21.67；95% CI，5.37 - 87.34；P < 0.001）以及体内手术操作（OR，5.63；95% CI，2.15 - 14.61；P < 0.001）是IH的独立显著危险因素。
胃癌MIS后IH并不常见。本研究中，女性、高BMI、肿瘤体积大及体内手术操作是其显著危险因素。因此，对于有危险因素的患者，外科医生在胃癌MIS后应谨慎关闭腹壁切口，以预防IH。
