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Risk factors and management of incisional hernia after cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal surface malignancies

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Abstract

Background

The incidence of incisional hernia in patients with peritoneal surface malignancies treated by cytoreduction plus hyperthermic intraperitoneal chemotherapy (HIPEC) remains unclear, and the criteria commonly used to indicate their repair cannot be applied in these patients. The objective of this work was to analyze the incidence of incisional hernias in these patients, identify the risk factors associated with their appearance, and propose an algorithm for their management.

Methods

We analyzed a series of patients with malignant pathologies of the peritoneal surface treated by cytoreduction with peritonectomy and HIPEC procedures between January 2008 and June 2017. Only patients with a minimum postoperative follow-up period of 12 months were included.

Results

Our series included 282 patients, 28 (10%) of whom developed an incisional hernia during the follow-up period. Fifty-one patients, all with ovarian cancer with peritoneal dissemination, did not receive HIPEC after cytoreduction as they were part of the control arm of the CARCINOHIPEC clinical trial (NCT02328716) or because they did not provide specific informed consent. In the multivariate analysis, treatment with HIPEC (OR 2.56, 95% CI [1.57, 4.31], p = 0.032) and the administration of preoperative systemic chemotherapy (OR = 1.59, 95% CI [1.26, 3.58], p = 0.041) were found to be independent factors related to the appearance of an incisional hernia.

Conclusions

The incidence of incisional hernia after cytoreduction and HIPEC is within the ranges described in the literature for other abdominal surgery procedures. The use of systemic chemotherapy and treatment with HIPEC, in particular, were identified as factors related to their occurrence.

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Authors and Affiliations

  1. Unit of Peritoneal Surface Malignancies Surgery, Department of General Surgery, Virgen de la Arrixaca University Hospital-IMIB Arrixaca, Carretera Madrid-Cartagena S/N, El Palmar, 30120, Murcia, Spain

    P. A. Cascales Campos, A. González-Gil, A. J. Gómez-Ruiz, E. Gil-Gómez, F. Alconchel-Gago, A. Navarro-Barrios & J. Gil-Martínez

  2. Department of Medical Oncology, Virgen de la Arrixaca University Hospital-IMIB Arrixaca, Murcia, Spain

    J. Martínez-García & J. L. Alonso-Romero

  3. Unit of Gynecologic Oncology, Department of Gynecology and Obstetrics, Virgen de la Arrixaca University Hospital-IMIB Arrixaca, Murcia, Spain

    A. Nieto & F. Barceló-Valcarcel

Authors
  1. P. A. Cascales Campos
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  2. A. González-Gil
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  3. A. J. Gómez-Ruiz
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  4. E. Gil-Gómez
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  5. F. Alconchel-Gago
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  6. A. Navarro-Barrios
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  7. J. Martínez-García
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  8. J. L. Alonso-Romero
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  9. A. Nieto
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  10. F. Barceló-Valcarcel
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  11. J. Gil-Martínez
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Corresponding author

Correspondence to P. A. Cascales Campos.

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Ethical approval was agreed by the ethical committee of the institution.

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The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Cascales Campos, P.A., González-Gil, A., Gómez-Ruiz, A.J. et al. Risk factors and management of incisional hernia after cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal surface malignancies. Hernia 24, 257–263 (2020). https://doi.org/10.1007/s10029-019-01962-4

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  • DOI: https://doi.org/10.1007/s10029-019-01962-4

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