Prior Radiotherapy Does Not Affect Abdominal Wall Reconstruction Outcomes: A Propensity Score Analysis

Introduction: Radiotherapy (XRT) adversely affects wound healing, but data are limited on how prior XRT may affect abdominal wall reconstruction (AWR) outcomes. We hypothesized that prior abdominal wall XRT is associated with worse outcomes following AWR for hernia or oncologic resection.

Methods: This was a retrospective study that included consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) at a single center. We performed propensity score analysis for risk adjustment in multivariable analysis and for one-to-one matching.

Results: We included 511 patients who underwent AWR with ADM for repair of a complex hernia and/or oncologic resection from 2005 to 2015. One hundred thirty (25%) patients underwent XRT prior to AWR and 381 (75%) patients did not undergo XRT. With a mean follow-up of 30.0 months, a greater percentage of XRT AWR patients underwent flap reconstruction (14.6% vs 5.0%, p<0.001), whereas fewer underwent component separation (61.5% vs 71.4%, p=0.036) compared with non-XRT AWR patients. Both groups had similar rates of hernia recurrence (8.5% vs 9.4%) and surgical site occurrence (25.4% vs 23.4%).

When the treatment method was adjusted for the propensity score (in addition to the propensity score matched pairs), these results persisted. However, XRT AWR patients had a significantly shorter time to hernia recurrence compared to non-XRT AWR patients (among the 182 propensity score-matched pairs; 11.28 vs 21.73 months, p=0.028). Differences in hernia recurrence, surgical site occurrence, and wound healing complication rates were not observed.

Conclusions: Contrary to our hypothesis, the only difference detected between XRT AWR and non-XRT AWR patients was a shorter time to hernia recurrence seen in the XRT AWR group. Surgeons should be aware of the higher likelihood of needing a flap for skin replacement when performing AWR in the setting of XRT.