Prevalence and risk factors for postoperative incisional hernia after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: a meta‑analysis and systematic review.

INTRODUCTION: The prevalence and risk factors for postoperative incisional hernia (IH) following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) remain uncertain, with published studies reporting highly variable outcomes. AIM: This systematic review and meta-analysis aimed to estimate the pooled prevalence of IH after CRS-HIPEC and risk factors associated with it. MATERIALS AND METHODS: A comprehensive search of the PubMed, Embase, and Cochrane Library databases was conducted to identify relevant observational studies. A total of 12 studies reporting IH after CRS-HIPEC were included. Study quality was assessed using the Newcastle-Ottawa Scale, and random-effects models were applied to calculate pooled prevalence and risk factors for postoperative IH following CRS-HIPEC. Subgroup, sensitivity, and publication bias analyses were performed to evaluate robustness of the findings. RESULTS: A total of 12 studies comprising 2170 patients were qualified for this review. The estimated average pooled prevalence of IH after CRS-HIPEC was 13% (95% CI, 9-16), with individual study estimates ranging from 6.9% to 26.9%, and substantial heterogeneity (I 2 = 85.2%). Subgroup analyses showed lower prevalence in prospective studies and larger cohorts, while multicenter studies demonstrated lower prevalence rates, as compared with single-center cohorts. Several risk factors were significantly associated with IH, including perioperative chemotherapy, bowel anastomosis or stoma formation, older age, obesity, and postoperative complications. Sensitivity analysis confirmed stability of the results, and the Egger test did not indicate significant small-study effects. CONCLUSIONS: IH is a notable and clinically relevant long-term complication following CRS-HIPEC. The risk of IH is driven primarily by patient age, obesity, perioperative chemotherapy exposure, gastrointestinal reconstruction, and postoperative complications.