title: Cancer Survivorship: Defining the Incidence of Incisional Hernia After Resection for Intra-Abdominal Malignancy.
abstract: Cancer survivorship focuses largely on improving quality of life. We aimed to determine the rate of ventral incisional hernia (VIH) formation after cancer resection, with implications for survivorship.
  
  
  
  Patients without prior VIH who underwent abdominal malignancy resections at a tertiary center were followed up to 2 years. Patients with a viewable preoperative computed tomography (CT) scan and CT within 2 years postoperatively were included. Primary outcome was postoperative VIH on CT, reviewed by a panel of surgeons uninvolved with the original operation. Factors associated with VIH were determined using Cox proportional hazards regression.
  
  
  
  1847 CTs were reviewed among 491 patients (59 % men), with inter-rater reliability 0.85 for the panel. Mean age was 60 ± 12 years; mean follow-up time 13 ± 8 months. VIH occurred in 41 % and differed across diagnoses: urologic/gynecologic (30 %), colorectal (53 %), and all others (56 %) (p < 0.001). Factors associated with VIH (adjusting for stage, age, adjuvant therapy, smoking, and steroid use) included: incision location [flank (ref), midline, hazard ratio (HR) 6.89 (95 %CI 2.43-19.57); periumbilical, HR 6.24 (95 %CI 1.84-21.22); subcostal, HR 4.55 (95 %CI 1.51-13.70)], cancer type [urologic/gynecologic (ref), other {gastrointestinal, pancreatic, hepatobiliary, retroperitoneal, and others} HR 1.86 (95 %CI 1.26-2.73)], laparoscopic-assisted operation [laparoscopic (ref), HR 2.68 (95 %CI 1.44-4.98)], surgical site infection [HR 1.60 (95 %CI 1.08-2.37)], and body mass index [HR 1.06 (95 %CI 1.03-1.08)].
  
  
  
  The rate of VIH after abdominal cancer operations is high. VIH may impact cancer survivorship with pain and need for additional operations. Further studies assessing the impact on QOL and prevention efforts are needed.
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. rebeccah.baucom@vanderbilt.edu.
authors.forename: Rebeccah B
authors.initials: RB
authors.lastname: Baucom
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ousley
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Gloria B
authors.initials: GB
authors.lastname: Beveridge
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.|Department of Biostatistics, Vanderbilt University, Nashville, TN, USA.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Phillips
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Pierce
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Holzman
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Sharp
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Nealon
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
mesh_terms: D000368:Aged; D015992:Body Mass Index; D004067:Digestive System Neoplasms / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006555:Hernia, Ventral / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D000069290:Incisional Hernia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012186:Retroperitoneal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014571:Urologic Neoplasms / Q000601:surgery*