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Session: ePoster: Colon and Colorectal Cancer 12 (Mon1015)

EP695 - Comparative Study of Incisional Hernia and Oncologic Outcomes in Rectal Cancer Patients Undergoing Laparoscopic LAR with Pfannenstiel or Periumbilical Incision

Monday, May 12, 2025
10:25 AM – 10:30 AM PT

    ePoster Presenter(s)

  • Seungyeon Kang, MD (she/her/hers)

    Fellow
    Severance Hospital, Yonsei university
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • SY

    Seung Yoon Yang, n/a

    Clinical assistant professor
    Severance Hospital
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Seungyeon Kang, MD: This individual has no financial relationships with ineligible companies.
Seung Yoon Yang, n/a: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: In rectal cancer patients undergoing laparoscopic low anterior resection (LAR), surgeons typically prefer the periumbilical site for specimen extraction over the Pfannenstiel site. This preference stems from concerns that using the Pfannenstiel incision requires additional mobilization up to the splenic flexure to prevent tension during extraction. Without this, there is a risk of compromising the proximal margin, which is critical for oncologic safety. However, the Pfannenstiel incision offers significant advantages, including a lower risk of incisional hernia and better cosmetic outcomes. Therefore, this study aims to compare the incidence of incisional hernia and oncologic outcomes between the Pfannenstiel and periumbilical extraction sites in patients undergoing laparoscopic LAR.

Methods/Interventions: A retrospective study was conducted on 234 patients who underwent laparoscopic LAR for rectal cancer between 2014 and 2018. Patients were divided into two groups based on the specimen extraction site: periumbilical (n=143) and Pfannenstiel (n=91). Data on patient demographics, operative details, and postoperative outcomes were collected. The primary outcome was the occurrence of incisional hernia, while secondary outcomes included and oncologic outcomes such as disease-free survival (DFS) and overall survival (OS), and other postoperative complications.

Results/Outcomes: The Pfannenstiel group had a significantly lower incidence of incisional hernia (0%) compared to the periumbilical group (7%, p=0.025). Factors such as age, gender, and BMI did not significantly influence the risk of IH. However, Pfannenstiel extraction was associated with a lower risk of incisional hernia (OR 4.91, 95% CI 1.13-27.56, p=0.033). No significant differences were observed between the groups in terms of SSI (p=0.112), anastomotic leaks (p=1.000). Oncologic outcomes, including lymph node retrieval, tumor size, and proximal/distal margin lengths, showed no significant differences between the two groups, indicating similar long-term survival and recurrence rates. There was also no difference in the number of metastatic lymph nodes or pathologic staging between the groups.

Conclusion/Discussion: Pfannenstiel incision significantly reduces the risk of incisional hernia compared to periumbilical extraction in laparoscopic LAR patients, with no adverse impact on oncologic outcomes.