Background/Objectives: An incisional hernia (IH) is a frequent postoperative complication after cytoreductive laparotomic surgery for advanced ovarian cancer (AOC). It occurs in 2–22% of patients in the first two years of follow-up, depending on the series. Although different risk factors have been described for various types of malignancies and surgeries, few studies have analyzed the risk factors for hernia development in ovarian cancer (OC). However, none have examined the role of enhanced recovery after surgery (ERAS) programs. Methods: We performed a retrospective study that included patients with AOC and primary or interval debulking surgery through a median laparotomic approach. This study was conducted in Vall d’Hebron Hospital, Barcelona, Spain, between January 2015 and December 2022. Univariate and multivariate regression analyses were conducted. Results: Of the 156 patients included, 30 (19.2%) presented with an IH. The patients with IHs were smokers in a higher proportion to non-smokers (53.9% vs. 16.1%,p= 0.003) and more frequently presented with wound dehiscence (34.4% vs. 15.0%,p= 0.026). Patients in whom negative pressure wound therapy was applied had a hernia less frequently than those who had not had it (12.5% vs. 26.7%,p= 0.043). Similarly, the incidence of hernia decreased when patients went through an ERAS protocol (10.1% vs. 28.8%,p= 0.008). In the multivariate analysis, smoking was the only independent risk factor (RR 10.84, CI 2.76–42.64), and applying an ERAS protocol was seen to be the sole protective factor (RR 0.22, CI 0.08–0.61) against the development of an IH. Conclusions: The implementation of ERAS is highly recommended due to its numerous benefits, most notably the reduction in hernia incidence. Additionally, the preoperative identification of current smokers provides an opportunity for smoking cessation and targeted respiratory prehabilitation, both of which further contribute to IH reduction.
背景/目的：切口疝是晚期卵巢癌减瘤开腹术后常见的并发症。根据不同的病例系列，术后两年内发生率在2%至22%之间。尽管针对不同类型的恶性肿瘤和手术已描述了多种风险因素，但鲜有研究专门分析卵巢癌患者发生切口疝的风险因素，且尚无研究探讨加速康复外科方案在此方面的作用。方法：本研究为回顾性分析，纳入2015年1月至2022年12月在西班牙巴塞罗那Vall d'Hebron医院接受中位开腹初次或间歇性减瘤手术的晚期卵巢癌患者。研究采用单因素及多因素回归分析。结果：在纳入的156例患者中，30例（19.2%）发生切口疝。切口疝患者中吸烟者比例显著高于非吸烟者（53.9% vs. 16.1%，p=0.003），且更常出现伤口裂开（34.4% vs. 15.0%，p=0.026）。接受负压伤口治疗的患者疝发生率低于未接受者（12.5% vs. 26.7%，p=0.043）。同样，接受加速康复外科方案的患者疝发生率显著降低（10.1% vs. 28.8%，p=0.008）。多因素分析显示，吸烟是唯一的独立危险因素（RR 10.84，CI 2.76–42.64），而实施加速康复外科方案是唯一的保护性因素（RR 0.22，CI 0.08–0.61）。结论：强烈推荐实施加速康复外科方案，因其具有多重获益，尤其可显著降低切口疝发生率。此外，术前识别当前吸烟者可为戒烟及针对性呼吸功能预康复提供契机，两者均有助于进一步减少切口疝发生。
肿瘤(癌症)患者之家