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Open versus laparoscopic rectal cancer resection and risk of subsequent incisional hernia repair and paracolostomy hernia repair: a nationwide population-based cohort study

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Abstract

Objective

To investigate the risk of incisional hernia repair (IHR) and paracolostomy hernia repair (PHR) following open and laparoscopic rectal cancer resection with curative intent.

Background

Laparoscopic rectal cancer resection has been implemented to varying degrees around the world. IHR and PHR following open and laparoscopic rectal cancer resection have only been sparingly evaluated.

Methods

Patients who underwent rectal cancer resection were identified in the Danish Colorectal Cancer Group’s database. To identify IHR and PHR following rectal cancer resection, we linked data to the Danish Ventral Hernia Database. The absolute risk of IHR and PHR was estimated as cumulative incidence proportions, treating death as competing risk. We used Cox proportional hazard regression analysis with multivariable adjustment to compute hazard ratios (HRs) comparing open and laparoscopic approach.

Results

The 5-year risk of IHR was 4.1% among patients undergoing open resection (n = 3090) and 3.2% among those undergoing laparoscopic resection (n = 3099), corresponding to a risk difference of 0.9% (95% CI 0.0–2.0, P = 0.057). Laparoscopic rectal resection was not associated with lower risk of IHR (adjusted HR 0.94, 95% CI 0.67–1.31, P = 0.709). A total of 2577 patients had a colostomy at rectal cancer resection and the 5-year risk of PHR was 2.1% after open surgery compared with 6.7% after laparoscopic surgery, corresponding to a risk difference of −4.6% (95% CI −6.4 to −2.7, P < 0.001). Laparoscopic surgery was associated with increased risk of PHR (adjusted HR 2.56, 95% CI 1.53–4.29, P < 0.001).

Conclusion

We observed no association between surgical approach of rectal cancer resection and subsequent IHR. Laparoscopic surgery was associated with increased risk of PHR.

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Funding

This study was supported by the Program for Clinical Research Infrastructure (PROCRIN Grant No. R1-005) established by the Lundbeck Foundation and the Novo Nordisk Foundation.

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Authors and Affiliations

  1. Department of Surgery, Section of Coloproctology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark

    Peter Andersen, Rune Erichsen, Søren Laurberg & Lene H. Iversen

  2. Department of Surgery, Regional Hospital Herning, Herning, Denmark

    Peter Andersen & Mogens R. Madsen

  3. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark

    Rune Erichsen & Trine Frøslev

  4. Danish Colorectal Cancer Group, Copenhagen, Denmark

    Lene H. Iversen

Authors
  1. Peter Andersen
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  2. Rune Erichsen
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  3. Trine Frøslev
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  4. Mogens R. Madsen
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  5. Søren Laurberg
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Corresponding author

Correspondence to Peter Andersen.

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Disclosures

Drs. Rune Erichsen, Trine Frøslev, and Lene H. Iversen were supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation. Drs. Peter Andersen, Mogens R. Madsen, and Søren Laurberg have no conflicts of interest or financial ties to disclose.

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Andersen, P., Erichsen, R., Frøslev, T. et al. Open versus laparoscopic rectal cancer resection and risk of subsequent incisional hernia repair and paracolostomy hernia repair: a nationwide population-based cohort study. Surg Endosc 32, 134–144 (2018). https://doi.org/10.1007/s00464-017-5648-0

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