Surgical Management Of The Secondary Neoplasm Of Abdominal Wall By Reconstruction With Mesh

Objective To evaluate the value and result of MESH repaire technique treat with secondary neoplasm of the abdominal wall.Methods Retrospective analysis the patients with secondary neoplasm of the abdominal wall in the Department of General Surgery, SIR Run Run Shaw Hospital, from Jan 2004 to Dec 2009. The patients' clinic data such as primary tumor pathologic diagnosis, first operation, the time part from abdominal wall occurrence secondary neoplasm, the location of abdominal wall secondary neoplasm, second operation method and time, MESH size, postoperative complications, length of stay, live time and the pain after operation.Results There were 12 patients accept in this research (M/8, F/4), with an average age of 58.2 (34～77). The primary disease were 4 cases of gastric cancer,2cases of hepetocellular carcinoma,3cases of colon cancer,1 case with colon lymphoma,1 gallbladder cancer,1 chronic cholecystitis (there is a mass on the trocar site 11 months after LC, and be confirmed it is the adenocarcinoma). Pain Scale in Visual Analog Scale before operation:5 cases have more than 8,6 cases have 5 to 7 scores,1 cases have less than 5 scores. The type of operation:all the 12 patients were received extended resection the mass of secondary neoplasm,1 patient combined jejunum-jejunum anastomosis,1 patient combined pediculated skin grafting. Operation time:62～132min (average 85min), blood loss:20～150ml (average 65m). The maximum diameter of the secondary neoplasm:4.5-13cm (average 5.8cm). The maximum diameter of abdominal-wall defect after resection the neoplasm:10.5-20cm (average 13.8cm). The type of MESH:5 peritonium preserved cases use prolene MESH, 7 full-thickness defect cases use dual antistick MESH. The size of MESH:10×15cm: 6 cases,15×15cm:3 cases,15×20cm:2 cases,20x30cm MESH:1 case. Operation result:all the cases recover well without death.,3 cases complicated incision seroma,2 cases complicated subcutaneou fluid collection, lcase complicated GI bleeding. The postoperative hospital stay days were 7～39d (average 19.1d). Follow-up:until May, 2010, there were 9 cases follow-up from 4～20 months, with an average of 7.9 months, all without local tumor recurrence or abdominal wall defect, the other 3 cases were lost. The survival time.4 cases survived more than 10 months, including 3 cases alive now (1 case received operation after right liver cancer operation 12 months have survived 10 months,1 case received operation after radical resection of gallbladder cancer 9 months have survived 11months,1 case received right hemicolectomy resection the abdominal wall mass at the same time have survived 20 months). The 3 alive patients'pain Scale is lower than before(3score,3score,4 score). The cause of death:5 cases died from cancer metastasis,1 case died from cerebral vascular accident.Conclusion It is helpful to perform extended resection for isolate or local secondary abdominal wall neoplasm and reconstruct the abdominal wall with MESH, it could relief the pain, improve their quality of life, and maybe prolong their life span...