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Surgical Endoscopy

Published in:

01-10-2016

Incisional hernias after open versus laparoscopic surgery for colonic cancer: a nationwide cohort study

Authors: Kristian K. Jensen, Peter-Martin Krarup, Thomas Scheike, Lars N. Jorgensen, Tommie Mynster

Published in: Surgical Endoscopy | Issue 10/2016

Abstract

Background

Laparoscopic surgery for colonic cancer decreases the incidence of postoperative complications and length of hospital stay as compared with open surgery, while the oncologic outcome remains equivalent. It is unknown whether the surgical approach impacts on the long-term rate of incisional hernia. Furthermore, risk factors for incisional hernia formation are not fully elucidated. The aim of this study was to evaluate the long-term effect of elective open versus laparoscopic surgery for colonic cancer on development of incisional hernia.

Methods

This nationwide cohort study included patients operated on electively for colonic cancer with primary anastomosis in Denmark from 2001 to 2008. Patient data were obtained from the database of the Danish Colorectal Cancer Group and merged with data from the National Patient Registry. Multivariable Cox regression and competing risks analysis were performed.

Results

A total of 8489 patients were included, with a median follow-up of 8.8 (interquartile range 7.0–10.7) years. The incidence of incisional hernia was increased among patients operated on with open techniques compared with patients undergoing laparoscopic surgery (7.3 vs. 5.2 %, p < 0.001). After adjustment for confounders, laparoscopic approach was associated with a decreased risk of incisional hernia formation (hazard ratio [HR] 0.62, 95 % confidence interval [CI] 0.44–0.89; p = 0.009). Other factors associated with increased risk of incisional hernia were wound infection, fascial dehiscence, anastomotic leak, and body mass index >25 kg/m².

Conclusions

This nationwide analysis demonstrated that laparoscopic as compared with open access for curative resection of colonic cancer was associated with a decreased risk of incisional hernia formation.

Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A, Werner J, Buchler MW, Diener MK (2014) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101:51–54CrossRefPubMed

Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571CrossRefPubMed

van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF (2012) Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg 204:144–150CrossRefPubMed

Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183CrossRefPubMed

Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:CD007781PubMed

Millbourn D, Cengiz Y, Israelsson LA (2009) Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 144:1056–1059CrossRefPubMed

Sorensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jorgensen LN (2005) Smoking is a risk factor for incisional hernia. Arch Surg 140:119–123CrossRefPubMed

Veljkovic R, Protic M, Gluhovic A, Potic Z, Milosevic Z, Stojadinovic A (2010) Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy. J Am Coll Surg 210:210–219CrossRefPubMed

Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, Brown JM (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82CrossRefPubMed

10.

Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7CrossRefPubMed

11.

Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H, Clinical Outcomes of Surgical Therapy Study G (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662CrossRefPubMed

12.

Colon Cancer Laparoscopic or Open Resection Study G, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52CrossRefPubMed

13.

Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K (2012) A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer. J Cancer 3:49–57CrossRefPubMedPubMedCentral

14.

Taylor GW, Jayne DG, Brown SR, Thorpe H, Brown JM, Dewberry SC, Parker MC, Guillou PJ (2010) Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial. Br J Surg 97:70–78CrossRefPubMed

15.

Burns EM, Currie A, Bottle A, Aylin P, Darzi A, Faiz O (2013) Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery. Br J Surg 100:152–159CrossRefPubMed

16.

Ihedioha U, Mackay G, Leung E, Molloy RG, O’Dwyer PJ (2008) Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 22:689–692CrossRefPubMed

17.

Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2:CD003432PubMed

18.

Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, Kono H, Yamamoto H, Ando M, Nagino M (2014) Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 101:1439–1447CrossRefPubMed

19.

Mishra A, Keeler BD, Maxwell-Armstrong C, Simpson JA, Acheson AG (2014) The influence of laparoscopy on incisional hernia rates: a retrospective analysis of 1057 colorectal cancer resections. Colorectal Dis 16:815–821CrossRefPubMed

20.

Andersen LP, Klein M, Gogenur I, Rosenberg J (2008) Incisional hernia after open versus laparoscopic sigmoid resection. Surg Endosc 22:2026–2029CrossRefPubMed

21.

Lynge E, Sandegaard JL, Rebolj M (2011) The Danish national patient register. Scand J Public Health 39:30–33CrossRefPubMed

22.

Nickelsen TN, Harling H, Kronborg O, Bulow S, Jorgensen T (2004) The completeness and quality of the Danish Colorectal Cancer clinical database on colorectal cancer. Ugeskr Laeger 166:3092–3095PubMed

23.

Krarup PM, Jorgensen LN, Andreasen AH, Harling H, Danish Colorectal Cancer G (2012) A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis 14:e661–e667CrossRefPubMed

24.

Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H (2014) Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg 259:930–938CrossRefPubMed

25.

Norskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrom LH (2015) Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188,064 patients registered in the Danish Anaesthesia Database. Anaesthesia 70:272–281CrossRefPubMed

26.

World Health Organization (2015) International Classification of Diseases (ICD) Information Sheet. http://www.who.int/classifications/icd/factsheet/en/. Accessed 11 May 2015

27.

Nordic Medico-Statistical Committee (NOMESCO 2009) version 1.14. NOMESCO classification of surgical procedures (NCSP). ISBN 978-87-89702-69-8. 2009

28.

Schmidt M, Jacobsen JB, Lash TL, Botker HE, Sorensen HT (2012) 25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study. BMJ 344:e356CrossRefPubMedPubMedCentral

29.

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335:806–808CrossRef

30.

Martinussen T, Scheike T (2006) Dynamic regression models for survival data, 1st edn. Springer-Verlag, New York

31.

Pintilie M (2011) An introduction to competing risks analysis. Rev Esp Cardiol 64:599–605CrossRefPubMed

32.

Schemper M, Smith TL (1996) A note on quantifying follow-up in studies of failure time. Control Clin Trials 17:343–346CrossRefPubMed

33.

Gerds TA, Scheike TH, Andersen PK (2012) Absolute risk regression for competing risks: interpretation, link functions, and prediction. Stat Med 31:3921–3930CrossRefPubMedPubMedCentral

34.

Eriksson F, Li J, Scheike T, Zhang MJ (2015) The proportional odds cumulative incidence model for competing risks. Biometrics 71:687–695CrossRefPubMedPubMedCentral

35.

Xu Q, Paik MC, Rundek T, Elkind MS, Sacco RL (2011) Reweighting estimators for Cox regression with missing covariate data: analysis of insulin resistance and risk of stroke in the Northern Manhattan Study. Stat Med 30:3328–3340CrossRefPubMedPubMedCentral

36.

Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192CrossRefPubMed

37.

Bartels SA, Vlug MS, Hollmann MW, Dijkgraaf MG, Ubbink DT, Cense HA, van Wagensveld BA, Engel AF, Gerhards MF, Bemelman WA (2014) Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study). Br J Surg 101:1153–1159CrossRefPubMed

38.

Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefPubMed

39.

Helgstrand F, Rosenberg J, Kehlet H, Jorgensen LN, Bisgaard T (2013) Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg 216:217–228CrossRefPubMed

40.

Xing L, Culbertson EJ, Wen Y, Franz MG (2013) Early laparotomy wound failure as the mechanism for incisional hernia formation. J Surg Res 182:e35–e42CrossRefPubMed

41.

Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T (2012) Reoperation versus clinical recurrence rate after ventral hernia repair. Ann Surg 256:955–958CrossRefPubMed

Title: Incisional hernias after open versus laparoscopic surgery for colonic cancer: a nationwide cohort study
Authors: Kristian K. Jensen
Peter-Martin Krarup
Thomas Scheike
Lars N. Jorgensen
Tommie Mynster
Publication date: 01-10-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-4779-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incisional hernias after open versus laparoscopic surgery for colonic cancer: a nationwide cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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