Subcutaneous Fat, Not Visceral Fat, as a Risk Factor for Incisional Hernia After Laparoscopic Colorectal Cancer Surgery.

INTRODUCTION: Postoperative incisional hernia impairs patients' quality of life and may require surgical intervention. This study investigated the risk of incisional hernia following laparoscopic colorectal cancer surgery. METHODS: In total, 199 patients who underwent laparoscopic colorectal cancer surgery were enrolled in this retrospective single-center study. The patients were divided into the no incisional hernia group (n = 185) and the incisional hernia group (n = 9). Subcutaneous fat area (SFA) and visceral fat area (VFA) at the level of the umbilicus were measured using specialized computed tomography imaging software. Data from an additional 78 patients who underwent laparoscopic colorectal cancer surgery in another hospital were used as a validation cohort. RESULTS: Nine patients (4.6%) were diagnosed with incisional hernia. Body mass index, SFA, and VFA were significantly higher in the hernia group than in the non-hernia group (p = 0.04, 0.004, and 0.03, respectively). In the multivariate analysis, only SFA of ≥ 167.8 cm2 remained an independent risk factor (odds ratio: 7.73, 95% confidence interval: 1.31-45.8, p = 0.02). Subcutaneous fat thickness (SFT), which can be easily measured on routine computed tomography scans, showed a strong correlation with SFA (coefficient = 0.779, p < 0.001) and was also significantly associated with incisional hernia. This association was validated in an independent cohort. CONCLUSION: High SFA was an independent risk factor for incisional hernia following laparoscopic colorectal cancer surgery. SFT may serve as a practical surrogate for SFA.