Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA.
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Gastrointest Surg. 2023 Nov;27(11):2388-2395. doi: 10.1007/s11605-023-05777-8. Epub 2023 Aug 3.
Incisional hernia (IH) is common after major abdominal surgery; however, the incidence after hepatectomy for cancer has not been described. We analyzed incidence of and risk factors for IH after hepatectomy for colorectal liver metastases (CLM).
Patients who underwent open hepatectomy with midline or reverse-L incision for CLM at a single institution between 2010 and 2018 were retrospectively analyzed. Postoperative CT scans were reviewed to identify IH and the time from hepatectomy to hernia. Cumulative IH incidence was calculated using competing risk analysis. Risk factors were assessed using Cox proportional hazards model analysis. The relationship between IH incidence and preoperative body mass index (BMI) was estimated using a generalized additive model.
Among 470 patients (median follow-up: 16.9 months), IH rates at 12, 24, and 60 months were 41.5%, 51.0%, and 59.2%, respectively. Factors independently associated with IH were surgical site infection (HR: 1.54, 95% CI 1.16-2.06, P = 0.003) and BMI > 25 kg/m (HR: 1.94, 95% CI 1.45-2.61, P < 0.001). IH incidence was similar in patients undergoing midline and reverse-L incisions and patients who received and did not receive a bevacizumab-containing regimen. The 1-year IH rate increased with increasing number of risk factors (zero: 22.2%; one: 46.8%; two: 60.3%; P < 0.001). Estimated IH incidence was 10% for BMI of 15 kg/m and 80% for BMI of 40 kg/m.
IH is common after open hepatectomy for CLM, particularly in obese patients and patients with surgical site infection. Surgeons should consider risk-mitigation strategies, including alternative fascial closure techniques.
切口疝（IH）是腹部大手术后的常见并发症；然而，尚未描述其在癌症肝切除术后的发生率。我们分析了单一机构在 2010 年至 2018 年间行开腹肝切除术治疗结直肠癌肝转移（CLM）患者的 IH 发生率和危险因素。
回顾性分析了在单一机构接受中线或反向 L 切口开腹肝切除术治疗 CLM 的患者。术后 CT 扫描用于识别 IH 和从肝切除术到疝的时间。使用竞争风险分析计算 IH 的累积发生率。使用 Cox 比例风险模型分析评估危险因素。使用广义加性模型估计 IH 发生率与术前体重指数（BMI）之间的关系。
在 470 例患者中（中位随访时间：16.9 个月），12、24 和 60 个月的 IH 发生率分别为 41.5%、51.0%和 59.2%。与 IH 独立相关的因素是手术部位感染（HR：1.54，95%CI 1.16-2.06，P=0.003）和 BMI＞25kg/m（HR：1.94，95%CI 1.45-2.61，P＜0.001）。接受和不接受贝伐珠单抗治疗方案的患者、接受中线和反向 L 切口的患者的 IH 发生率相似。IH 发生率随着危险因素数量的增加而增加（零：22.2%；一：46.8%；二：60.3%；P＜0.001）。BMI 为 15kg/m 时 IH 发生率为 10%，BMI 为 40kg/m 时 IH 发生率为 80%。
开腹肝切除术治疗 CLM 后 IH 很常见，尤其是肥胖患者和手术部位感染患者。外科医生应考虑包括替代筋膜闭合技术在内的降低风险策略。
