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The journal «ONCOSURGERY» 2012, Vol.4, No 4

Chemotherapy as a factor of complex influence on the incidence of postoperative ventral hernias in treatment of malignant abdominal tumors

Zimin YI, Chichevatov DA

Penza institute for advanced training of physicians, Penza, Russia
Contact: Chichevatov DA, e-mail:

The objective was to study consideration chemotherapy as one of the factors that having influence on the incidence of postoperative ventral hernias in oncological patients.

Materials and methods. The treatment results in 181 patients with malignant tumors were analyzed. There were 58 (32.04%) male and 123 (67.96%) female patients. Age varied between 32 and 82 years old, the average age was 57.77±9.54. The patients were observed in the period from 3 month after the surgery (during chemotherapy) to one year past, when the treatment was over. All the patients underwent surgery for malignant tumors of the abdominal organs: stomach (53), ovaries (50), colon (31), rectum (24), uterus (23). Neoadjuvant and adjuvant chemotherapy were in 101 (55.80%) cases of 181.

Results. Postoperative ventral hernia was registered in 48 (26.5%) cases. In case of monofactorial analysis of 11 potential predictors there were 6 predictors which determined a connection with hernia development (primary tumor localization (р=0.001), chemotherapy caring out (p<0.001), number of chemotherapy courses (p<0.001), surgical approach (р=0.012), of ther localization (p<0.001), extent of operation (р=0.022), sex (р=1.000), age (р=0.218), tumor stage (р=0.200), number of prior laparotomy (р=0.067), comorbidity (р=0.126)).

Regression analysis revealed that tumor localization in ovarium (р=0.017), stomach (р=0.005), number of chemotherapy courses (р<0.001) and the absence of cancer at other sites in the medical history (р=0.005) had a strong influence on hernia formation. The satisfactory regression model was received with determination coefficient of R2=0.320. Notable is that excluding any of the mentioned predictors from the model leaded to the significant loss of its quality.

According to the results of monofactorial (p>0.5) and multifactorial (p>0.1) analysis none of the inquired chemotherapy schemes had statistically significant influence on hernia formation.

In patients with no risk factors determined in the regression model the incidence of hernia formation was not more than 15%. In presence of 1 or 2 factors the hernia was registered in 30-40% cases. And finally, a combination of 3 factors was associated with the hernia formation in 80% cases. This difference is statically significant (p<0.05).

Conclusion:

  1. Presence of postoperative ventral hernias in oncological patients is a serious problem because of its high incidence.
  2. The chemotherapy is an independent risk-factor of hernia formation, the number of courses play a main role.
  3. Chemotherapy as a risk-factor is important in complex with other factors, such as primary tumor localization, presence of primary-multi focal tumors.
  4. The presence of 1 or more risk-factors leads to 30% and more higher chance of hernia developing, what could be the reason for preventive application of plastics technologies, which will promote the improvement of the patient’s quality of life in case of the radical treatment.

KEY WORDS: Chemotherapy, postoperative ventral hernia, prognosis.

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