Jason T Wiseman1, Charles Kimbrough1, Eliza W Beal1, Mohammad Y Zaidi2, Charles A Staley2, Travis Grotz3, Jennifer Leiting3, Keith Fournier4, Andrew J Lee4, Sean Dineen5, Benjamin Powers5, Jula Veerapong6, Joel M Baumgartner6, Callisia Clarke7, Sameer H Patel8, Vikrom Dhar8, Ryan J Hendrix9, Laura Lambert10, Daniel E Abbott11, Courtney Pokrzywa11, Mustafa Raoof12, Byrne Lee12, Nadege Fackche13, Jonathan Greer13, Timothy M Pawlik1, Sherif Abdel-Misih1, Jordan M Cloyd14. 1. Department of Surgery, The Ohio State University, Columbus, OH, USA. 2. Department of Surgery, Emory University, Atlanta, GA, USA. 3. Department of Surgery, Mayo Clinic, Rochester, MN, USA. 4. Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA. 6. Department of Surgery, University of California, San Diego, San Diego, CA, USA. 7. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 8. Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA. 9. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA. 10. Department of Surgery, Huntsman Cancer Institute, Salt Lake City, UT, USA. 11. Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA. 12. Department of Surgery, City of Hope Cancer Center, Duarte, CA, USA. 13. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. 14. Department of Surgery, The Ohio State University, Columbus, OH, USA. jordan.cloyd@osumc.edu.
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.
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.
Authors: S P Somashekhar; Kumar C Rohit; Yethadka Ramya; Shabber S Zaveri; Vijay Ahuja; Arun Kumar Namachivayam; K R Ashwin Journal: Ann Surg Oncol Date: 2021-08-30 Impact factor: 5.344
Authors: Kevin M Turner; Mackenzie C Morris; Aaron M Delman; Dennis Hanseman; Fabian M Johnston; Jonathan Greer; Kara Vande Walle; Daniel E Abbott; Mustafa Raoof; Travis E Grotz; Keith Fournier; Sean Dineen; Jula Veerapong; Ugwuji Maduekwe; Anai Kothari; Charles A Staley; Shishir K Maithel; Laura A Lambert; Alex C Kim; Jordan M Cloyd; Gregory C Wilson; Jeffrey J Sussman; Syed A Ahmad; Sameer H Patel Journal: J Gastrointest Surg Date: 2022-10-18 Impact factor: 3.267
Authors: Leonidas Chardalias; Antonios Gklavas; Ira Sotirova; Erasmia Vlachou; John Kontis; Ioannis Papaconstantinou Journal: Int J Surg Case Rep Date: 2020-06-13
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