Oncology - Bladder, Renal, Test
Mid-Atlantic Section 76th Annual Meeting
Introduction & Objective :
Postoperative incisional hernias (PIH) are a well-established complication of abdominal surgery; however, contemporary rates after radical cystectomy (RC) are not well-established, especially since the introduction of robot-assisted techniques. Moreover, risk factors that may predict PIH have not been described. Herein, we assess and compare rates of PIH after robotic assisted radical cystectomy (RARC) and open radical cystectomy (ORC), and identify factors that may predict PIH in these cohorts.
Patients with >1 year follow up and available pre- and post-operative cross-sectional imaging who had undergone ORC from 2000-2015 (n=381) and RARC from 2007-2015 (n=88) at our tertiary referral cancer center were included in this study. Infra-umbilical midline incision was performed during ORC and a periumbilical incision during RARC with extracorporeal urinary diversion. Patient demographics, type of urinary diversion and presence of preoperative umbilical hernia were evaluated. Skin-to-fascia depth (SFD) as well as rectus diastasis width (RDW) were captured from pre-operative imaging. Post-operative imaging was examined for presence of PIH.
Of the 469 patients that met inclusion criteria, the incidence of PIH in our cohort was 14.3%. Analysis revealed no statistically significant differences in PIH rates between open and robotic cohorts (15.8% vs 25.4%, p=0.144). Age, gender, smoking status, diabetes, receipt of chemotherapy, and race did not correlate with PIH on multivariate analysis (all p>0.05). Increasing BMI was associated with a slightly increased risk of PIH (OR 1.07, 95%CI 1.01-1.13, p=0.02). Stratified by surgical approach, receipt of an ileal conduit compared to continent diversion was associated with a deceased risk of PIH in only the open cohort (OR 0.37, 95%CI 0.15-0.89, p=0.025). In the RARC cohort, preoperative umbilical hernia significantly increased the risk of PIH on multivariate analysis (OR 7.83, 95%CI 1.90-32.25, p=0.004).
After adjustment, increased supraumbilical RDW was a risk factor for PIH on multivariate analysis in patients who had an ORC (OR 1.9, 95%CI 1.15-3.17, p=0.013). Conversely, patients undergoing RARC had no increased risk of PIH based on supraumbilical (p=0.436) or infraumbilical (p=0.347) RDW. SFD did not correlate with hernia rates in any of our patient cohorts (all p values > 0.05).
Patients undergoing RC are at significant risk of PIH regardless of surgical approach. Anthropomorphic factors and urinary diversion type appear to be associated with PIH risk. Further research is needed to understand how risks of PIH can be reduced in patients undergoing cystectomy.