title: Incisional hernia after open resections for colorectal liver metastases - incidence and risk factors.
abstract: Incisional hernia is one of the most common complications after laparotomy. The aim of this retrospective study was to investigate incidence, location and risk factors for incisional hernia after open resection for colorectal liver metastases including the use of perioperative chemotherapy and targeted therapy evaluated by computed tomography.
  
  
  
  Patients operated for colorectal liver metastases between 2010 and 2013 were included. Incisional hernia was defined as a discontinuity in the abdominal fascia observed on computed tomography.
  
  
  
  A total of 256 patients were analyzed in regard to incisional hernia. Seventy-eight patients (30.5%) developed incisional hernia. Hernia locations were midline alone in 66 patients (84.6%) and involving the midline in another 8 patients (10.3%). In multivariate analysis, preoperative chemotherapy >6 cycles (hazard ratio 2.12, 95% confidence interval 1.14-3.94), preoperative bevacizumab (hazard ratio 3.63, 95% confidence interval 1.86-7.08) and incisional hernia from previous surgery (hazard ratio 3.50, 95% confidence interval 1.98-6.18) were found to be independent risk factors.
  
  
  
  Prolonged preoperative chemotherapy and also preoperative bevacizumab were strong predictors for developing an incisional hernia. After an extended right subcostal incision, the hernia location was almost exclusively in the midline.
authors.affiliation: Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Nilsson
authors.affiliation: Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Strandberg Holka
authors.affiliation: Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden. Electronic address: christian.sturesson@med.lu.se.
authors.forename: Christian
authors.initials: C
authors.lastname: Sturesson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects; D000068258:Bevacizumab / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D000069290:Incisional Hernia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab