Abstract
BackgroundPatients with peritoneal malignancy often have multiple laparotomies before referral for cytoreductive surgery (CRS). Some have substantial abdominal wall herniation and tumour infiltration of abdominal incisions. CRS involves complete macroscopic tumour removal and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdominal wall reconstruction is problematic in these patients. The aim of this study was to establish immediate and long‐term outcomes of abdominal wall reconstruction with biological mesh in a single centre.MethodsA dedicated peritoneal malignancy database was searched for all patients who had biological mesh abdominal wall reconstruction between 2004 and 2015. Short‐ and long‐term outcomes were reviewed. All patients had annual abdominal CT as routine peritoneal malignancy follow‐up.ResultsSome 33 patients (22 women) with a mean age of 53·4 (range 19–82) years underwent abdominal wall reconstruction with biological mesh. The majority (23) had CRS for pseudomyxoma (19 low grade), six for colorectal peritoneal metastasis and four for appendiceal adenocarcinoma; 18 had undergone CRS and HIPEC previously. Twenty‐five of the 33 patients had abdominal wall tumour involvement and eight had concurrent hernias. The mean duration of surgery was 486 (range 120–795) min and the mean mesh size used was 345 (50–654) cm2. Ten patients developed wound infections and four had a seroma. Two developed early enterocutaneous fistulas. Mean follow‐up was 48 months. Five patients developed an incisional hernia. Four died from progressive malignancy. A further 15 patients had disease recurrence, but only one had isolated abdominal wall recurrence.ConclusionBiological mesh was safe and effective for abdominal wall reconstruction in peritoneal malignancy. Postoperative wound infections were frequent but nevertheless incisional hernia rates were low with no instances of mesh‐related bowel erosion or fistulation.
Highlights
The optimal approach for selected patients with peritoneal malignancy involves complete macroscopic tumour removal, known as cytoreductive surgery (CRS), combined with hyperthermic intraperitoneal chemotherapy (HIPEC)[1,2]
The following information was retrieved for all patients: demographic data, diagnosis (PMP or colorectal peritoneal metastases (CPM)), primary or recurrent treatment, direct involvement of the abdominal wall or presence of an incisional hernia at presentation, operative details, mesh type and size
Thirty-three patients (22 women) underwent CRS, HIPEC and abdominal wall reconstruction using biological mesh between 2004 and 2015. These 33 patients accounted for 2⋅7 per cent of 1229 patients treated by CRS and HIPEC over that interval
Summary
The optimal approach for selected patients with peritoneal malignancy involves complete macroscopic tumour removal, known as cytoreductive surgery (CRS), combined with hyperthermic intraperitoneal chemotherapy (HIPEC)[1,2]. At referral, many have an incisional hernia, and some have tumour infiltration of the abdominal wall (Figs 1 and 2), and require abdominal wall reconstruction after CRS and HIPEC. The aim of this study was to establish immediate and long-term outcomes of abdominal wall reconstruction with biological mesh in a single centre. Methods: A dedicated peritoneal malignancy database was searched for all patients who had biological mesh abdominal wall reconstruction between 2004 and 2015. Results: Some 33 patients (22 women) with a mean age of 53⋅4 (range 19–82) years underwent abdominal wall reconstruction with biological mesh. Conclusion: Biological mesh was safe and effective for abdominal wall reconstruction in peritoneal malignancy. Presented to the Annual Scientific Meeting of the Association of Coloproctology of Great Britain and Ireland, Edinburgh, UK, July 2016 and the Tenth International Congress of Peritoneal Malignancies, Washington DC, USA, November 2016; published in abstract form as Colorectal Dis 2016; 18(Suppl S2): 72 and J Peritoneum 2016; 1(Suppl 1): 23
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