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Hernia

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Early repair of ventral incisional hernia may improve quality of life after surgery for abdominal malignancy: a prospective observational cohort study

  • M. P. Feng
  • R. B. Baucom
  • K. K. Broman
  • D. A. Harris
  • M. D. Holzman
  • L.-C. Huang
  • J. L. Kaiser
  • S. L. Kavalukas
  • O. O. Oyefule
  • S. E. Phillips
  • B. K. Poulose
  • R. A. PierceEmail author
Original Article

Abstract

Purpose

Recent work has shown that over 40% of patients undergoing surgery for abdominal malignancy develop ventral incisional hernias (VIH) within 2 years. We hypothesized that early repair of VIH for cancer survivors could improve long-term quality of life (QoL).

Methods

All patients presenting with a history of surgery for abdominal malignancy and a VIH were prospectively enrolled. QoL was assessed at baseline and 3-, 6-, 12-, 18-, and 24-month follow-up using abdominal wall-specific (HerQLes) and cancer-specific (FACT-G) instruments. At the study’s conclusion, patients were divided into 2 groups—those that underwent VIH repair during the study’s course (Repair Group) and those that did not (Control Group). Categorical variables were analyzed using Pearson’s Chi-square and continuous variables with Wilcoxon rank sum test.

Results

Eighty-four patients were enrolled. Overall, 46 patients (55%) underwent VIH repair, with 36 repairs (78%) occurring within 3 months of initial evaluation. Sixty-six (79%) had complete 1-year follow-up data, and 30 (36%) had 2-year data, with a median follow-up duration of 15.6 months. At baseline, both groups were similar with respect to demographics, cancer stage, and HerQLes/FACT-G scores. Compared to the Controls, the Repair Group showed greater improvements over baseline HerQLes Summary Scores at the 3-, 6-, 12-, and 18-month time points (median increase, 37 vs. 26 points), and in FACT-G total scores at the 3-, 6-, and 12-month time points (median increase, 6 vs. 4 points).

Conclusions

Repair of VIH after surgery for abdominal malignancy may improve abdominal wall-specific and cancer-specific QoL, making post-resection abdominal wall reconstruction an important aspect of cancer survivorship.

Keywords

Incisional hernia Cancer survivorship Abdominal malignancy Quality of life Prospective cohort study Hernia prevention 

Notes

Author contributions

Study concept and design: MPF, RBB, KKB, DAH, MDH, LCH, JLK, SEP, OOO, BKP, RAP. Patient enrollment: MPF, RBB, DAH, MDH, JLK, SLK, OOO, BKP, RAP. Data collection and analysis: MPF, RBB, KKB, LCH, JLK, SLK, SEP, BKP, RAP. Manuscript drafting and critical review: MPF, RBB, KKB, DAH, MDH, LCH, JLK, SLK, OOO, SEP, BKP, RAP.

Compliance with ethical standards

Conflict of interest

Dr. Pierce receives research funding from Intuitive Surgical Solutions, and consulting fees/honoraria from AbbVie. His spouse is an employee of, and thus receives a salary from, BD/CareFusion. These relationships have no impact on the current work. Dr. Poulose receives research funding from Bard/Davol and salary support from The Americas Hernia Society Quality Collaborative. These relationships have no impact on the current work. Drs. Baucom, Broman, Harris, Holzman, Huang, Kavalukas, and Oyefule, as well as Mr. Feng, Ms. Kaiser, and Ms. Phillips declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This study includes human participants and has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments. No animal studies were performed.

Informed consent

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

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of SurgeryBaylor University Medical Center, Baylor Scott & WhiteDallasUSA
  3. 3.Department of Surgery, Office of Surgical EducationEmory University School of MedicineAtlantaUSA
  4. 4.Department of BiostatisticsVanderbilt University Medical CenterNashvilleUSA
  5. 5.Department of General SurgeryCleveland Clinic FloridaWestonUSA

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