Concomitant Ventral Hernia Repair and Gastrointestinal Cancer Surgery: A Systematic Review of Approaches and Safety

Abstract

Aim:

Ventral hernias are frequently encountered in patients undergoing gastrointestinal (GI) cancer surgery, creating a clinical dilemma regarding whether to perform concomitant ventral hernia repair (VHR) during oncologic resection. While mesh-based repair reduces recurrence in elective settings, its use in potentially contaminated fields remains controversial due to concerns regarding surgical site infection (SSI), reoperation, and impaired recovery in a vulnerable oncologic population. Therefore, this systematic review aims to evaluate the perioperative outcomes regarding concomitant VHR during GI cancer surgery.

Material and Methods:

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and the Cochrane Handbook. PubMed, Embase, Cochrane Library, and Scopus were searched from inception to October 2025. Studies including adult patients undergoing simultaneous VHR (with or without mesh) during GI cancer surgery were eligible. Primary outcomes included SSI, reoperation, length of hospital stay (LOS), recurrence, and postoperative mortality. Risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomized Studies of Interventions-I tool. Due to substantial clinical and methodological heterogeneity, meta-analysis was not performed, and findings were synthesized descriptively.

Results:

Eight observational studies were included. A total sample of 11,141 patients was studied, with 4566 patients with a diagnosed neoplasm undergoing surgery. Out of these, most procedures involved colorectal malignancies (n = 3695; 80.9%) and were performed electively (86.7%) via an open approach. Thirty-day mortality rates were consistently low (0–3.4%) and comparable between mesh and no-mesh groups. SSI rates varied widely (5.6–21.7%), with inconsistent differences between cohorts. Reoperation rates ranged from 0% to 27%, and LOS varied from approximately 3 to 11 days. Hernia recurrence, when reported, reached up to 40% in studies with longer follow-ups. Considerable heterogeneity was observed in cancer type, contamination level, mesh material and placement, use of component separation, and follow-up duration. All studies were judged to have a moderate risk of bias, primarily due to confounding and nonrandomized design.

Conclusion:

Concomitant VHR during GI cancer surgery appears feasible and is not associated with increased short-term mortality. However, variability in SSI, reoperation, and recurrence rates underscores the complexity of patient selection and operative decision-making in oncologic populations. Given the heterogeneity and moderate risk of bias of available evidence, prospective multicenter studies with standardized reporting are needed to better define optimal reconstructive strategies and risk-stratified treatment algorithms.