# The Impact of Prophylactic Negative Wound Pressure Treatment (NWPT) on Surgical Site Occurrences After Gynecologic Cancer Surgery: A Meta-Analysis of Randomized Controlled and Observational Cohort Studies

## TL;DR

This study reviews the use of negative pressure wound treatment to reduce post-surgery complications in gynecologic cancer patients, finding some benefits but no strong statistical proof.

## Contribution

The paper provides a meta-analysis on the effectiveness of negative pressure wound treatment in reducing surgical site complications after gynecologic cancer surgery.

## Key findings

- ci-NPWT systems showed lower SSI rates, but results were not statistically significant.
- ci-NPWT systems were associated with lower fascial dehiscence and seroma formation rates.
- ci-NPWT systems had higher postoperative hematoma formation rates, though not statistically significant.

## Abstract

Oncologic outcomes of gynecologic cancer patients undergoing surgery could be influenced by several factors including postoperative complications. Surgical wound infections still remain an important postoperative side effect even after gynecologic oncological operations. Their incidence has been related to patient-related and wound-related risk factors. However, not several preventive measures have been proved efficient yet. Negative pressure wound treatment systems have been implicated to play a potential role in preventing such postoperative complications. Our meta-analysis demonstrated lower wound-related postoperative complications in patients treated with negative pressure wound treatment systems compared to conventional gauze after gynecologic oncologic surgery. Nevertheless, these comparisons did not reach statistical significance. Under these circumstances, prospective randomized trials should be designed to investigate the impact of negative pressure wound treatment on preventing surgical wound infections after gynecologic oncology surgery.

Background: Surgical site infections (SSIs) remain a serious problem following abdominal surgery due to gynecologic malignancies leading to increased hospitalization, high costs, and delays in adjuvant treatments; thus, SSIs affect overall survival. The aim of the present meta-analysis was to investigate the impact of closed incision–negative pressure wound treatment (ci-NPWT) systems on postoperative surgical site occurrences (SSOs) after gynecologic oncology surgery. Methods: The present meta-analysis was designed using the PRISMA guidelines. A search in several databases was conducted from inception until March 2025. Results: Overall, five studies were included; these studies enrolled 1174 patients in total, where 412 were treated with ci-NPWT systems and 762 were treated with conventional gauze. Patients treated with ci-NPWT systems presented with lower SSI rates (OR 0.40, 95% CI 0.15–1.10, p = 0.08), lower fascial dehiscence rates (OR 0.72, 95% CI 0.21–2.42, p = 0.59), and lower seroma formation rates (OR 0.70, 95% CI 0.25–1.93, p = 0.49), although statistical significance was not reached in all comparisons. On the other hand, patients treated with ci-NPWT systems also presented with higher postoperative hematoma formation rates (OR 1.38, 95% CI 0.32–5.99, p = 0.66), although statistical significance was not reached. Preoperative patient characteristics, operative parameters, and cancer characteristics were similar among the two study groups. Conclusions: The prophylactic use of ci-NPWT systems showed promising results in reducing postoperative SSOs after gynecologic cancer surgery. Nevertheless, prospectively designed studies are needed in the future to reach robust evidence that would enable the wide implementation of such devices in routine clinical practice.