ABSTRACT
PURPOSE: The potential impact of abdominal wound dehiscence on long-term survival after elective abdominal surgery is largely unknown. The aim of this study was to examine the impact of abdominal wound dehiscence on survival and incisional hernia repair after elective, open colonic cancer resection. METHODS: This was a nationwide cohort study based on merged data from Danish national registries, comprising patients subjected to elective, open resection for colonic cancer between May 1, 2001 and January 1, 2016. Multivariable Cox Regression analysis and propensity score matching was applied to adjust for confounding. The associations of abdominal wound dehiscence with 90-day mortality and subsequent incisional hernia repair were also examined. RESULTS: A total of 14,169 patients were included in the cohort, of which 549 (3.9%) developed abdominal wound dehiscence. The 5-year survival was significantly decreased in patients with abdominal wound dehiscence (42.4%, 95% CI 38.1-46.7 vs. 53.4%, 52.6-54.3, P < 0.001), which was confirmed in the multivariable analysis (HR 1.22, CI 1.06-1.39, P = 0.004). Abdominal wound dehiscence was significantly associated with increased risk of 90-day mortality (OR 1.60, CI 1.12-2.27, P = 0.009) as well as subsequent incisional hernia repair (HR 1.80, CI 1.07-3.01, P = 0.026). CONCLUSIONS: Abdominal wound dehiscence was significantly associated with decreased survival. Fascial closure after open colonic cancer resection should be given high priority to improve the long-term survival.
Subject(s)
Abdominal Injuries , Colonic Neoplasms , Hernia, Ventral , Incisional Hernia , Abdominal Injuries/complications , Cohort Studies , Colonic Neoplasms/surgery , Follow-Up Studies , Hernia, Ventral/surgery , Herniorrhaphy/adverse effects , Humans , Incisional Hernia/complications , Incisional Hernia/etiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Surgical Wound Dehiscence/epidemiology , Surgical Wound Dehiscence/etiology , Surgical Wound Dehiscence/surgeryABSTRACT
BACKGROUND AND AIMS: Perianal Crohn's disease [CD] places a considerable burden on patients' quality of life and is complex to treat. Despite its impact and high frequency, few studies have investigated the incidence and disease course of perianal CD. The aim of this study was to assess the incidence and disease course of perianal CD in adult patients throughout a 19-year period. METHODS: The cohort comprised all individuals aged 18 years or older who were diagnosed with CD in Denmark between January 1, 1997, and December 31, 2015, according to the National Patient Registry [NPR]. RESULTS: A total of 1812 [19%] out of 9739 patients with CD were found to have perianal CD. Perianal fistulas were the most common manifestation, accounting for 943 [52%] cases. The incidence of perianal CD remained stable over time. Patients with perianal CD were found to have an increased risk of undergoing major abdominal surgery compared with patients without perianal CD (hazard ratio: 1.51, 95% confidence interval [CI]: 1.40 to 1.64, pâ <0.001) in a multivariate Cox regression analysis. The incidence rate ratios of anal and rectal cancer in perianal CD patients were 11.45 [95% CI: 4.70 to 27.91, pâ <0.001] and 2.29 [95% CI: 1.25 to 4.20, pâ =â 0.006], respectively, as compared with non-IBD matched controls. CONCLUSIONS: In this nationwide study, 19% of CD patients developed perianal disease. Patients with perianal CD were at increased risk of undergoing major surgery compared with non-perianal CD patients. The risk of anal and rectal cancer was increased in patients with perianal CD compared with non-IBD matched controls. PODCAST: This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
Subject(s)
Anus Diseases , Crohn Disease , Digestive System Surgical Procedures , Quality of Life , Rectal Neoplasms/epidemiology , Adult , Anus Diseases/diagnosis , Anus Diseases/epidemiology , Anus Diseases/psychology , Anus Diseases/surgery , Crohn Disease/diagnosis , Crohn Disease/epidemiology , Crohn Disease/psychology , Crohn Disease/surgery , Denmark/epidemiology , Digestive System Surgical Procedures/methods , Digestive System Surgical Procedures/statistics & numerical data , Female , Humans , Incidence , Male , Registries/statistics & numerical data , Risk Assessment/statistics & numerical dataABSTRACT
AIM: An anastomotic leak after surgery for colon cancer is a recognized complication but how it may adversely affect long-term survival is less clear because data are scarce. The aim of the study was to investigate the long-term impact of Grade C anastomotic leak in a large, population-based cohort. METHOD: Data on patients undergoing resection for Stage I-III colon cancer between 2008 and 2012 were collected from the Swedish, Norwegian and Danish Colorectal Cancer Registries. Overall relative survival and conditional 5-year relative survival, under the condition of surviving 1 year, were calculated for all patients and stratified by stage of disease. RESULTS: A total of 22 985 patients were analysed. Anastomotic leak occurred in 849 patients (3.7%). Five-year relative survival in patients with anastomotic leak was 64.7% compared with 87.0% for patients with no leak (P < 0.001). Five-year relative survival among the patients who survived the first year was 88.6% vs 81.3% (P = 0.003). Stratification by cancer stage showed that anastomotic leak was significantly associated with decreased relative survival in patients with Stage III disease (P = 0.001), but not in patients with Stage I or II (P = 0.950 and 0.247, respectively). CONCLUSION: Anastomotic leak after surgery for Stage III colon cancer was associated with significantly decreased long-term relative survival.
