Early repair of ventral incisional hernia may improve quality of life after surgery for abdominal malignancy: a prospective observational cohort study
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).
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.
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).
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.
KeywordsIncisional hernia Cancer survivorship Abdominal malignancy Quality of life Prospective cohort study Hernia prevention
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.
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 was obtained from all individual participants included in the study.
- 1.Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–399. https://doi.org/10.1097/01.sla.0000086662.49499.ab (discussion 399–400) CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Baucom RB, Ousley J, Beveridge GB, Phillips SE, Pierce RA, Holzman MD, Sharp KW, Nealon WH, Poulose BK (2016) Cancer survivorship: defining the incidence of incisional hernia after resection for intra-abdominal malignancy. Ann Surg Oncol 23(Suppl 5):764–771. https://doi.org/10.1245/s10434-016-5546-z CrossRefPubMedGoogle Scholar
- 8.Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215(5):635–642. https://doi.org/10.1016/j.jamcollsurg.2012.06.412 CrossRefPubMedGoogle Scholar
- 9.Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579. https://doi.org/10.1200/JCO.19184.108.40.2060 CrossRefPubMedGoogle Scholar
- 11.Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010 CrossRefGoogle Scholar
- 12.Poulose BK, Roll S, Murphy JW, Matthews BD, Todd Heniford B, Voeller G, Hope WW, Goldblatt MI, Adrales GL, Rosen MJ (2016) Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia: J of Hernias Abdom Wall Surg 20(2):177–189. https://doi.org/10.1007/s10029-016-1477-7 CrossRefGoogle Scholar
- 13.Jensen KK (2017) Recovery after abdominal wall reconstruction. Dan Med J 64(3):B5349-1–B5349-14Google Scholar
- 17.Rogmark P, Petersson U, Bringman S, Ezra E, Osterberg J, Montgomery A (2016) Quality of life and surgical outcome 1 year after open and laparoscopic incisional hernia repair: PROLOVE: a randomized controlled trial. Ann Surg 263(2):244–250. https://doi.org/10.1097/SLA.0000000000001305 CrossRefPubMedGoogle Scholar
- 19.Ravn S, Thaysen HV, Harslof S, Sorensen MM, Iversen LH (2018) Incisional hernia and its impact on health-related quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a national prospective cohort study. World J Surg Oncol 16(1):85. https://doi.org/10.1186/s12957-018-1382-x CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FPH, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386(10000):1254–1260. https://doi.org/10.1016/S0140-6736(15)60459-7 CrossRefPubMedGoogle Scholar
- 23.Bhangu A, Fitzgerald JE, Singh P, Battersby N, Marriott P, Pinkney T (2013) Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy. Hernia: J Hernias Abdom Wall Surg 17(4):445–455. https://doi.org/10.1007/s10029-013-1119-2 CrossRefGoogle Scholar
- 24.Borab ZM, Shakir S, Lanni MA, Tecce MG, MacDonald J, Hope WW, Fischer JP (2017) Does prophylactic mesh placement in elective, midline laparotomy reduce the incidence of incisional hernia? A systematic review and meta-analysis. Surgery 161(4):1149–1163. https://doi.org/10.1016/j.surg.2016.09.036 CrossRefPubMedGoogle Scholar
- 25.Donahue TF, Cha EK, Bochner BH (2016) Rationale and early experience with prophylactic placement of mesh to prevent parastomal hernia formation after ileal conduit urinary diversion and cystectomy for bladder cancer. Curr Urol Rep 17(2):9. https://doi.org/10.1007/s11934-015-0565-z CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Janes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, Lopez-Cano M, Maggiori L, Mandala V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Smietanski M, Szczepkowski M, Stabilini C, Muysoms FE (2018) European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia: J Hernias Abdom Wall Surg 22(1):183–198. https://doi.org/10.1007/s10029-017-1697-5 CrossRefGoogle Scholar