Age, Preoperative Subcutaneous Fat Area, and Open Laparotomy are Risk Factors for Incisional Hernia following Colorectal Cancer Surgery.
BACKGROUND
Although incisional hernia (IH) is a common complication of abdominal surgery, the incidence rate and risk factors are not well known. The objectives of this study are to determine the incidence rate of IH following colorectal cancer surgery and to describe the associated risk factors.


METHODS
Between 2005 and 2010, patients who underwent surgery to treat colorectal cancer were examined. The diagnosis of IH was performed by CT scan, and the visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus were calculated using a 3D-image analysis system. Survival analysis was used to assess the incidence and risk factors of IH.


RESULTS
A total of 626 patients (326 open, 300 laparoscopic) were included in this study, with median follow-up of 54 (range 2-97) months. Forty patients were diagnosed with postoperative IH, and the cumulative, 5-year incidence of IH was 7.3 %. Univariate analysis revealed that age, body mass index, waist circumference, hip circumference, open laparotomy, wound infection, VFA, and SFA were significantly associated with incidence of IH. Multivariate analysis revealed that age [hazard ratio (HR) 1.043 (1.005-1.083), p = 0.027], open laparotomy [HR 4.410 (1.018-19.095), p = 0.047], and SFA [HR 1.013 (1.004-1.022), p = 0.005] were significant risk factors for developing IH.


CONCLUSIONS
Higher age and SFA, along with open surgery, are risk factors for developing IH.
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Toru
T
Yamada
Department of Surgery, Keio University School of Medicine, Tokyo, Japan. okabayashikoji@gmail.com.
Koji
K
Okabayashi
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Hirotoshi
H
Hasegawa
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Masashi
M
Tsuruta
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Yuta
Y
Abe
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Takashi
T
Ishida
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Shimpei
S
Matsui
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Yuko
Y
Kitagawa
D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D000069290:Incisional Hernia / Q000453:epidemiology / Q000209:etiology*; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D050151:Subcutaneous Fat / Q000473:pathology*