Postoperative Outcomes of Concurrent Ventral Mesh Herniorrhaphy at the Time of Gastrointestinal Cancer Surgery

BACKGROUND: Concurrent ventral hernia repair with mesh (mVHR) at the time of gastrointestinal (GI) cancer resection remains controversial due to concerns of increased skin and soft tissue infections (SSTIs) and mesh-related complications, which may delay receipt of systemic cancer therapies and affect both surgical and oncologic outcomes. Given the health and quality-of-life burden imposed by hernias, we sought to analyze the safety of concurrent mVHR and GI cancer resection. STUDY DESIGN: The American College of Surgeons NSQIP database was queried for patients who underwent resection of GI malignancy and concurrent open VHR (with and without mesh) from 2016 to 2022. Perioperative outcomes of mVHR vs primary VHR (pVHR) were assessed before and after 1:2 propensity score matching. The primary outcome was 30-day postoperative SSTI rate. RESULTS: Of 3,449 patients undergoing concurrent VHR with GI cancer resection, 224 (6.5%) underwent mVHR. After matching (n = 174 mVHR; n = 305 pVHR), mVHR was found to be associated with longer operative time (242.5 vs 170 minutes, p < 0.001) and length of stay (7 vs 5 days, p = 0.002). The overall complication rate was higher in the mVHR cohort (43.1% vs 28.2%, p = 0.001), but there was no significant difference in SSTI rate (7.5% vs 5.6%, p = 0.410). mVHR was associated with higher rates of readmission (20.7% vs 11.5%, p = 0.006), blood transfusion (20.7% vs 10.5%, p = 0.006), and reoperation (8.6% vs 3.6%, p = 0.020). CONCLUSIONS: Of patients undergoing hernia repair concurrently with GI cancer resection, only 6.5% of patients underwent mVHR. mVHR was not associated with increased 30-day postoperative SSTIs vs pVHR but was associated with increased length of stay and other postoperative complications. Patient selection for concurrent mVHR must weigh the benefits of durable mesh-based repair with increased perioperative morbidity.