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Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Technique Matter? Ann Surg Oncol 2020 Mar;27(3):783-792

Date

10/30/2019

Pubmed ID

31659645

DOI

10.1245/s10434-019-07964-x

Scopus ID

2-s2.0-85074730542   10 Citations

Abstract

BACKGROUND: Anastomotic failure (AF) after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) remains a dreaded complication. Whether specific factors, including anastomotic technique, are associated with AF is poorly understood.

METHODS: Patients who underwent CRS-HIPEC including at least one bowel resection between 2000 and 2017 from 12 academic institutions were reviewed to determine factors associated with AF (anastomotic leak or enteric fistula).

RESULTS: Among 1020 patients who met the inclusion criteria, the median age was 55 years, 43.9% were male, and the most common histology was appendiceal neoplasm (62.3%). The median Peritoneal Cancer Index was 14, and 93.2% of the patients underwent CC0/1 resection. Overall, 82 of the patients (8%) experienced an AF, whereas 938 (92.0%) did not. In the multivariable analysis, the factors associated with AF included male gender (odds ratio [OR], 2.2; p < 0.01), left-sided colorectal resection (OR 10.0; p = 0.03), and preoperative albumin (OR 1.8 per g/dL; p = 0.02).Technical factors such as method (stapled vs hand-sewn), timing of anastomosis, and chemotherapy regimen used were not associated with AF (all p > 0.05). Anastomotic failure was associated with longer hospital stay (23 vs 10 days; p < 0.01), higher complication rate (90% vs 59%; p < 0.01), higher reoperation rate (41% vs 9%; p < 0.01), more 30-day readmissions (59% vs 22%; p < 0.01), greater 30-day mortality (9% vs 1%; p < 0.01), and greater 90-day mortality (16% vs 8%; p = 0.02) as well as shorter median overall survival (25.6 vs 66.0 months; p < 0.01).

CONCLUSIONS: Among patients undergoing CRS-HIPEC, AF is independently associated with postoperative morbidity and worse long-term outcomes. Because patient- and tumor-related, but not technical, factors are associated with AF, operative technique may be individualized based on patient considerations and surgeon preference.

Author List

Wiseman JT, Kimbrough C, Beal EW, Zaidi MY, Staley CA, Grotz T, Leiting J, Fournier K, Lee AJ, Dineen S, Powers B, Veerapong J, Baumgartner JM, Clarke C, Patel SH, Dhar V, Hendrix RJ, Lambert L, Abbott DE, Pokrzywa C, Raoof M, Lee B, Fackche N, Greer J, Pawlik TM, Abdel-Misih S, Cloyd JM

Author

Callisia N. Clarke MD Assistant Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Anastomosis, Surgical
Antineoplastic Combined Chemotherapy Protocols
Chemotherapy, Adjuvant
Chemotherapy, Cancer, Regional Perfusion
Combined Modality Therapy
Cytoreduction Surgical Procedures
Female
Follow-Up Studies
Humans
Hyperthermia, Induced
Male
Neoplasms
Prognosis
Retrospective Studies
Survival Rate