The impact of incisional hernia on mortality after colonic cancer resection.

Abstract

Long-term mortality after colonic cancer is not only related to the disease itself, but also to other factors such as surgical complications. Incisional hernia after abdominal surgery is a common complication; however, the impact on mortality is unknown. We thus sought to examine the impact of incisional hernia on mortality after colonic cancer resection. This was a nationwide cohort study comprising data from the Danish Colorectal Cancer Group's database, the Danish National Patient Registry (NPR), and the Danish Central Person Registry. Patients who underwent curatively intended colonic resection for cancer with primary anastomosis between 2001 and 2008 were included. The exposure of interest was incisional hernia, as registered in the NPR, and the outcome was long-term overall mortality. Extended cox regression analysis was used to adjust for confounding variables including age, gender, comorbidity, tumor stage, and surgical approach at the index operation as well as postoperative anastomotic leakage, adjuvant chemotherapy and cancer recurrence. A total of 9214 patients were followed for median 6.4years, during which 647 (7.0%) were diagnosed with incisional hernia, 431 (4.7%) underwent hernia repair, and 4631 (50.3%) died. In the multivariable analysis, incisional hernia diagnosis was not associated with increased mortality (adjusted hazard ratio 0.81, 95% confidence interval 0.70-0.93). Incarceration of the incisional hernia was associated with increased mortality (adjusted hazard ratio 2.35, 95% confidence interval 1.39-3.98), while incisional hernia repair did not increase mortality (adjusted hazard ratio 0.81, 95% confidence interval 0.68-0.97). Incisional hernia diagnosis or repair subsequent to colonic cancer resection did not increase mortality, albeit in the rare cases of incarceration.