H Jacoby1, Y Berger1, L Barda1, N Sharif1, Y Zager1, A Lebedyev1, M Gutman1, A Hoffman2. 1. Department of Surgery and Transplantation, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel Hashomer, Ramat Gan, Israel. 2. Department of Surgery and Transplantation, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel Hashomer, Ramat Gan, Israel. Aviad.Hoffman@sheba.health.gov.il.
Abstract
BACKGROUND: Formation of protective stoma as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) may be an effective tool in reducing anastomotic leak incidence. Our aim was to evaluate the incidence and implications of stoma formation during CRS-HIPEC and to examine whether a creation of protective stoma reduces the postoperative morbidity. METHODS: A cohort retrospective analysis of all CRS-HIPEC procedures performed between 2004 and 2016 was conducted. Predicting factors for stoma formation were assessed by comparing all patients who underwent stoma formation to those who did not; both groups were then restricted to cases with ≥2 bowel anastomoses and compared in terms of perioperative outcomes in order to determine whether protective stoma confers a morbidity benefit. RESULTS: One hundred and ninety-nine CRS-HIPEC procedures were performed on 186 patients. Thirty-four patients (17%) underwent stoma formation, 24 of them as protective stoma. Formation of a stoma was correlated with higher peritoneal carcinomatosis index score (13.6 ± 8 vs. 9.5 ± 7.7, p = 0.007), larger number of organs resected (p < 0.001), greater number of anastomoses (p < 0.001), prolonged operative time (8.1 ± 2.7 vs. 6.6 ± 2.2 h, p = 0.002), and prolonged hospital stay (12 vs. 8.5 days, p = 0.001). In procedures requiring ≥2 anastomoses, formation of protective stoma reduced the anastomotic leak rate (6 vs. 37%, p = 0.025), the morbidity rate (6 vs. 41%, p = 0.017), and reoperation rate (0 vs. 28%, p = 0.03). Overall, 15 patients (44%) underwent stoma reversal, 3 of whom had a complication treated non-operatively. CONCLUSIONS: Protective stoma should be considered in extensive CRS-HIPEC procedures requiring two or more bowel anastomoses in order to reduce the postoperative morbidity rate.
BACKGROUND: Formation of protective stoma as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) may be an effective tool in reducing anastomotic leak incidence. Our aim was to evaluate the incidence and implications of stoma formation during CRS-HIPEC and to examine whether a creation of protective stoma reduces the postoperative morbidity. METHODS: A cohort retrospective analysis of all CRS-HIPEC procedures performed between 2004 and 2016 was conducted. Predicting factors for stoma formation were assessed by comparing all patients who underwent stoma formation to those who did not; both groups were then restricted to cases with ≥2 bowel anastomoses and compared in terms of perioperative outcomes in order to determine whether protective stoma confers a morbidity benefit. RESULTS: One hundred and ninety-nine CRS-HIPEC procedures were performed on 186 patients. Thirty-four patients (17%) underwent stoma formation, 24 of them as protective stoma. Formation of a stoma was correlated with higher peritoneal carcinomatosis index score (13.6 ± 8 vs. 9.5 ± 7.7, p = 0.007), larger number of organs resected (p < 0.001), greater number of anastomoses (p < 0.001), prolonged operative time (8.1 ± 2.7 vs. 6.6 ± 2.2 h, p = 0.002), and prolonged hospital stay (12 vs. 8.5 days, p = 0.001). In procedures requiring ≥2 anastomoses, formation of protective stoma reduced the anastomotic leak rate (6 vs. 37%, p = 0.025), the morbidity rate (6 vs. 41%, p = 0.017), and reoperation rate (0 vs. 28%, p = 0.03). Overall, 15 patients (44%) underwent stoma reversal, 3 of whom had a complication treated non-operatively. CONCLUSIONS: Protective stoma should be considered in extensive CRS-HIPEC procedures requiring two or more bowel anastomoses in order to reduce the postoperative morbidity rate.
Authors: O Glehen; D Osinsky; E Cotte; F Kwiatkowski; G Freyer; S Isaac; V Trillet-Lenoir; A C Sayag-Beaujard; Y François; J Vignal; F N Gilly Journal: Ann Surg Oncol Date: 2003-10 Impact factor: 5.344
Authors: Terence C Chua; Greg Robertson; Winston Liauw; Rhonda Farrell; Tristan D Yan; David L Morris Journal: J Cancer Res Clin Oncol Date: 2009-08-23 Impact factor: 4.553
Authors: Thomas J Miner; Jinru Shia; David P Jaques; David S Klimstra; Murray F Brennan; Daniel G Coit Journal: Ann Surg Date: 2005-02 Impact factor: 12.969
Authors: Andrea N Doud; Edward A Levine; Nora F Fino; John H Stewart; Perry Shen; Konstantinos I Votanopoulos Journal: Ann Surg Oncol Date: 2015-06-16 Impact factor: 5.344
Authors: Matthew D Whealon; John V Gahagan; Sarath Sujatha-Bhaskar; Michael P O'Leary; Matthew Selleck; Sinziana Dumitra; Byrne Lee; Maheswari Senthil; Alessio Pigazzi Journal: Ann Surg Oncol Date: 2017-04-14 Impact factor: 5.344
Authors: Erienne M V de Cuba; Victor J Verwaal; Ignace H J T de Hingh; Leonieke J J van Mens; Simon W Nienhuijs; Arend G J Aalbers; Hendrik J Bonjer; Elisabeth A te Velde Journal: Ann Surg Oncol Date: 2013-11-18 Impact factor: 5.344
Authors: Lisa Überrück; Giorgi Nadiradze; Can Yurttas; Alfred Königsrainer; Ingmar Königsrainer; Philipp Horvath Journal: Ann Surg Oncol Date: 2020-11-09 Impact factor: 5.344
Authors: Femke A van der Zant; Bob J L Kooijman; Judith E K R Hentzen; Wijnand Helfrich; Emily M Ploeg; Robert J van Ginkel; Barbara L van Leeuwen; Lukas B Been; Joost M Klaase; Patrick H J Hemmer; Christian S van der Hilst; Schelto Kruijff Journal: BJS Open Date: 2022-09-02