ASO Author Reflections: Impact of Operative Technique on Anastomotic Failure During Cytoreductive Surgery for Peritoneal Malignancies—Surgeon Preference is Fine

Excerpt

Anastomotic failure (AF) after gastrointestinal surgery is a dreaded complication and has a reported incidence of 8–12%.1 Extensive efforts have been previously undertaken to explain risk factors for AF in patients with gastrointestinal surgery and the associated sequela of such an event.2,3 However, the incidence of AF, risk factors for its occurrence, and the long-term outcomes of patients with AF following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) are poorly understood. Unique to CRS/HIPEC is the administration of HIPEC, which has been previously speculated to increase the incidence and worsen the sequela of AF following CRS. These observations have prompted the operative surgeon to wrestle with the task of strategizing optimal technique to minimize risk of AF. For example, should the surgeon perform a hand-sewn or stapled restorative bowel anastomosis? Should the anastomosis be performed before or after HIPEC? Because few studies have previously investigated factors associated with the development of AF following CRS-HIPEC, the focus of this study was to investigate technical and other perioperative factors that are associated with AF using a large multi-institutional database. The secondary goal was to describe the incidence of AF as well as its impact on the short- and long-term outcomes of patients undergoing CRS-HIPEC.4 …