TY - JOUR
T1 - Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
T2 - Does Technique Matter?
AU - Wiseman, Jason T.
AU - Kimbrough, Charles
AU - Beal, Eliza W.
AU - Zaidi, Mohammad Y.
AU - Staley, Charles A.
AU - Grotz, Travis
AU - Leiting, Jennifer
AU - Fournier, Keith
AU - Lee, Andrew J.
AU - Dineen, Sean
AU - Powers, Benjamin
AU - Veerapong, Jula
AU - Baumgartner, Joel M.
AU - Clarke, Callisia
AU - Patel, Sameer H.
AU - Dhar, Vikrom
AU - Hendrix, Ryan J.
AU - Lambert, Laura
AU - Abbott, Daniel E.
AU - Pokrzywa, Courtney
AU - Raoof, Mustafa
AU - Lee, Byrne
AU - Fackche, Nadege
AU - Greer, Jonathan
AU - Pawlik, Timothy M.
AU - Abdel-Misih, Sherif
AU - Cloyd, Jordan M.
N1 - Publisher Copyright:
© 2019, Society of Surgical Oncology.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/85074730542
U2 - 10.1245/s10434-019-07964-x
DO - 10.1245/s10434-019-07964-x
M3 - Article
C2 - 31659645
AN - SCOPUS:85074730542
SN - 1068-9265
VL - 27
SP - 783
EP - 792
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 3
ER -