Incisional Hernia in Cytoreductive Surgery for Advanced-Stage Ovarian Cancer: A Single-Center Retrospective Study

Area of Science:

• Oncology
• Surgical Oncology
• Abdominal Surgery

Background:

• Incisional hernia (IH) is a common complication following cytoreductive laparotomy for advanced ovarian cancer (AOC).
• Risk factors for IH in AOC patients are not well-established, and the role of Enhanced Recovery After Surgery (ERAS) programs remains unexamined.

Purpose of the Study:

• To identify risk factors for IH development in patients undergoing surgery for AOC.
• To evaluate the impact of ERAS programs on IH incidence in this patient population.

Main Methods:

• Retrospective study of 156 patients with AOC undergoing median laparotomy for debulking surgery (January 2015 - December 2022).
• Univariate and multivariate regression analyses were performed to assess risk factors and protective elements.

Main Results:

• The incidence of IH was 19.2% (30/156 patients).
• Smoking (53.9% vs. 16.1%, p=0.003) and wound dehiscence were associated with higher IH rates.
• Negative pressure wound therapy and ERAS protocols showed a protective effect, reducing IH incidence (12.5% vs. 26.7%, p=0.043 and 10.1% vs. 28.8%, p=0.008, respectively).
• Multivariate analysis identified smoking as the sole independent risk factor and ERAS as the sole protective factor (RR 0.22, CI 0.08-0.61).

Conclusions:

• ERAS implementation is strongly recommended to decrease IH incidence in AOC patients.
• Preoperative identification of smokers for cessation and prehabilitation can further mitigate IH risk.