Wound complications after midline laparotomy in endometrial cancer patients. A multicentric trial.

Objective: To evaluate the role of constitutional, clinical and surgical factors in the development of wound complications following midline laparotomy for endometrial cancer.Methods: A database created for a multicentric randomized clinicaltrial comparing two different methods of fascial closure was used to identify patients undergoing total or radical hysterectomy through a midline laparotomy for endometrial cancer. A total of 617 patients were followed to detect the occurrence of early (infection, dehiscence) and late (incisional hernia) postoperative wound complications.Patients who presented an early and/or late woundcomplication (Group 1, n¼513), were compared to those who didnot (Group 2, n¼104).Results: The median patients age was significantly higher in Group1 than in Group 2 (67 [45—81] vs 63 [30—94] years, p<.05). Theproportion of women with diabetes was 21% in Group 1 comparedto 10% in Group 2 (p<.01). The median (range) BMI was higher inpatients who developed a wound complication than in those whodid not (29 [20—48] vs 26 [10—51] kg/m2, p<.05). The closure of thefascia was more frequently performed by experienced surgeons inGroup 1 compared to Group 2 (68.4% vs 49.5%, p<.001). Multiplelogistic regression analysis showed that the presence of diabeteswas the only independent risk factor for wound complications(OR 2.24 [CI 1.28—3.91], p<.005).Conclusions: Wound complications following gynecologic surgeryfor endometrial cancer seem to be related to metabolic disorderssuch as diabetes more than to surgical technique or other coexisting medical conditions.