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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2017

01-12-2017 | Colorectal Cancer

Institutional Experience with Ostomies Created During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion

Authors: Sam Pakraftar, MD, Lekshmi Ramalingam, MD, Yongli Shuai, MS, Heather L. Jones, MPA-C, James F. Pingpank, MD, Steven S. Ahrendt, MD, Matthew P. Holtzman, MD, Amer H. Zureikat, MD, Herbert J. Zeh, MD, David L. Bartlett, MD, Haroon A. Choudry, MD, FACS

Published in: Annals of Surgical Oncology | Issue 13/2017

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Abstract

Background

Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC) is a complex procedure that often requires ostomy creation to protect high-risk anastomoses. This study aimed to evaluate the authors’ institutional experience with CRS-HIPEC-associated ostomies, determine predictors of ostomy creation and reversal, and assess their impact on survival.

Methods

The study analyzed clinicopathologic, perioperative, and oncologic data from a prospective database of 1435 CRS-HIPEC procedures for peritoneal metastases. The Kaplan–Meier method was used to estimate survival. Multivariate analyses identified associations with ostomy creation/reversal and survival.

Results

Ostomies were created in 34% of the patients, most commonly loop ileostomies (82%). Loop ileostomies were reversed in the majority of patients (83%), whereas non-loop ileostomies were infrequently reversed (< 10% reversal rate). In a multivariate logistic regression model, intermediate or high tumor grade, colectomy/proctectomy, longer operative time, and lower Charlson comorbidity index were associated with loop ileostomy creation, whereas incomplete macroscopic resection, colorectal histology, and major postoperative complications were associated with non-reversal of loop ileostomy. In a multivariate Cox proportional hazards model, intermediate or high tumor grade and non-reversal of loop ileostomy were associated with worse overall survival.

Conclusions

Loop ileostomies were almost always reversed, whereas non-loop ileostomies were almost always permanent. Hospital readmissions for loop ileostomy-related complications were common. Therefore, formal outpatient protocols for prevention and management should be implemented. Non-reversal of loop ileostomy was associated with very poor survival.
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Metadata
Title
Institutional Experience with Ostomies Created During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion
Authors
Sam Pakraftar, MD
Lekshmi Ramalingam, MD
Yongli Shuai, MS
Heather L. Jones, MPA-C
James F. Pingpank, MD
Steven S. Ahrendt, MD
Matthew P. Holtzman, MD
Amer H. Zureikat, MD
Herbert J. Zeh, MD
David L. Bartlett, MD
Haroon A. Choudry, MD, FACS
Publication date
01-12-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6114-x

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