SUPRAPUBIC TRANSVERSE MINILAPAROTOMY DECREASES RADIOLOGICAL INCISIONAL HERNIAS IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
Eugenio Grasset*1,2, Matías Callejas3, Rodrigo San Martín3, Christophe Riquoir4, Maria Molina1, Felipe Bellolio1, Gonzalo Urrejola1, Rodrigo Migueles1, Jose T. Larach1
1Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile; 2Department of Surgery, Universidad de Chile, Santiago, Chile; 3Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile; 4Pontificia Universidad Católica de Chile, Santiago, Chile
Introduction
Laparoscopic colorectal cancer surgery (LCS) has shown short-term benefits and long-term equivalent oncological results, but it has not been established that the extraction site (ES) of the operative piece has a lower incidence of incisional hernias (IH).
Objective
To compare the rate of IH according to the ES in patients undergoing LCS. Our secondary objective was to identify risk factors for IH in LCS.
Methods
We conducted a prospective non-concurrent cohort study including patients registered in our prospective database that underwent LCS from September 2006 to December 2017 in a university hospital. The ES was a median mini-laparotomy (MM) or suprapubic transverse minilaparotomy (STM) according to surgeons' preference. The presence of IH (hernias of the ES and port sites) was determined in the computed tomography (CT) one year after the LCS, evaluated by two radiologists blinded to the original procedure. We excluded patients converted to open procedures, patients without follow-up CT in our institution or with non-specified ES. We compared the IH rate according to the ES used. Analytical statistics and regression models for evaluation were used. For a power of 80% and a significance of 95%, to demonstrate a difference in HI rates of 20%, the calculated sample size is 124.
Results
We included 256 patients, mean age of 62.5 (SD= 13.0) years, 53.9% where men with a mean BMI of 26,4 (3,9). In 46.9% MM was performed. There were no differences between the groups in BMI, follow-up time, comorbidities, use of tobacco or stage of cancer. The MM group was associated with a higher average age (64.6 versus 60.6, p = 0.01), less rectal surgery (32.5% versus 64.7%, p <0.001), lower use of adjuvant therapy (42.7% versus 59.4%, p = 0.01) and neoadjuvant therapy (21.6 versus 52.3%) than STM. The IH rate was 26.7% versus 10.2% p = 0.002, respectively with OR for MM versus STM for presenting IH of 3.2 (1.6 - 6.7, p = 0.001). When adjusting for covariates, the OR was 4.1 (1.16 - 16.7, p = 0.02). In the multivariate analysis, age and ES were independently associated with IH.
Conclusion
STM is associated with a lower IH rate in patients undergoing LCS. Age and SE were independently associated with IH.
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