Top

World Journal of Surgery

Published in:

01-07-2018 | Original Scientific Report

Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Authors: H. Jacoby, Y. Berger, L. Barda, N. Sharif, Y. Zager, A. Lebedyev, M. Gutman, A. Hoffman

Published in: World Journal of Surgery | Issue 7/2018

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.

Koppe MJ, Boerman OC, Oyen WJ et al (2006) Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg 243:212–222CrossRefPubMedPubMedCentral

Mirnezami R, Mehta AM, Chandrakumaran K et al (2014) Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy improves survival in patients with colorectal peritoneal metastases compared with systemic chemotherapy alone. Br J Cancer 111(8):1500–1508CrossRefPubMedPubMedCentral

Moran B, Baratti D, Yan TD et al (2008) Consensus statement on the loco-regional treatment of appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei). J Surg Oncol 98(4):277–282CrossRefPubMed

Chua TC, Robertson G, Liauw W et al (2009) Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in ovarian cancer peritoneal carcinomatosis: systematic review of current results. J Cancer Res Clin Oncol 135(12):1637–1645CrossRefPubMed

Baratti D, Kusamura S, Cabras AD et al (2013) Diffuse malignant peritoneal mesothelioma: long-term survival with complete cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Eur J Cancer 49(15):3140–3148CrossRefPubMed

Kuijpers AM, Mirck B, Aalbers AG et al (2013) Cytoreduction and HIPEC in The Netherlands: nationwide long-term outcome following the Dutch protocol. Ann Surg Oncol 20(13):4224–4230CrossRefPubMedPubMedCentral

Baratti D, Kusamura S, Mingrone E et al (2012) Identification of a subgroup of patients at highest risk for complications after surgical cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg 256(2):334–341CrossRefPubMed

Quenet F, Goéré D, Mehta SS et al (2011) Results of two bi-institutional prospective studies using intraperitoneal oxaliplatin with or without irinotecan during HIPEC after cytoreductive surgery for colorectal carcinomatosis. Ann Surg 254(2):294–301CrossRefPubMed

Glehen O, Osinsky D, Cotte E et al (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10(8):863–869CrossRefPubMed

10.

Makrin V, Lev-Chelouche D, Even Sapir E et al (2005) Intraperitoneal heated chemotherapy affects healing of experimental colonic anastomosis: an animal study. J Surg Oncol 89(1):18–22CrossRefPubMed

11.

Wu SW, Ma CC, Yang Y (2014) Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis. World J Gastroenterol 20(47):18031–18037CrossRefPubMedPubMedCentral

12.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

13.

Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. In: Sugarbaker PH (ed) Peritoneal carcinomatosis: principles of management. Kluwer Academic publishers, Boston, pp 359–374CrossRef

14.

Sugarbaker PH (1999) Management of peritoneal-surface malignancy: the surgeon’s role. Langenbecks Arch Surg 384(6):576–587CrossRefPubMed

15.

Verwaal VJ, van Ruth S, de Bree E et al (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21(20):3737–3743CrossRefPubMed

16.

Spiliotis J, Halkia E, Lianos E et al (2015) Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann Surg Oncol 22(5):1570–1575CrossRefPubMed

17.

Yan TD, Welch L, Black D et al (2006) A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma. Ann Oncol 18(5):827–834CrossRefPubMed

18.

Mo S, Cai G (2016) Multidisciplinary treatment for colorectal peritoneal metastases: review of the literature. Gastroenterol Res Pract. https://doi.org/10.1155/2016/1516259 PubMedPubMedCentralCrossRef

19.

Miner TJ, Shia J, Jaques DP et al (2005) Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy. Ann Surg 241(2):300–308CrossRefPubMedPubMedCentral

20.

Gusani NJ, Cho SW, Colovos C et al (2008) Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center. Ann Surg Oncol 15(3):754–763CrossRefPubMed

21.

Passot G, Vaudoyer D, Villeneuve L (2017) A perioperative clinical pathway can dramatically reduce failure-to-rescue rates after cytoreductive surgery for peritoneal carcinomatosis: a retrospective study of 666 consecutive cytoreductions. Ann Surg 265(4):806–813CrossRefPubMed

22.

Sugarbaker PH (2016) Avoiding diverting ileostomy in patients requiring complete pelvic peritonectomy. Ann Surg Oncol 23(5):1481–1485CrossRefPubMed

23.

Doud AN, Levine EA, Fino NF et al (2016) Stoma creation and reversal after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 23(2):503–510CrossRefPubMed

24.

Berger Y, Aycart S, Mandeli JP et al (2015) Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: outcomes from a single tertiary center. Surg Oncol 24(3):264–269CrossRefPubMed

25.

Casado-Adam A, Alderman R, Stuart OA et al (2011) Gastrointestinal complications in 147 consecutive patients with peritoneal surface malignancy treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy. Int J Surg Oncol. https://doi.org/10.1155/2011/468698 PubMedPubMedCentralCrossRef

26.

Dagbert F, Thievenaz R, Decullier E et al (2016) Splenectomy increases postoperative complications following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 23(6):1980–1985CrossRefPubMed

27.

Chouliaras K, Levine EA, Fino N et al (2017) Prognostic factors and significance of gastrointestinal leak after cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol 24(4):890–897CrossRefPubMed

28.

Whealon MD, Gahagan JV, Sujatha-Bhaskar S et al (2017) Is fecal diversion needed in pelvic anastomoses during hyperthermic intraperitoneal chemotherapy (HIPEC)? Ann Surg Oncol 24(8):2122–2128CrossRefPubMed

29.

Riss S, Chandrakumaran K, Dayal S et al (2015) Risk of definitive stoma after surgery for peritoneal malignancy in 958 patients: comparative study between complete cytoreductive surgery and maximal tumor. Eur J Surg Oncol 41(3):392–395CrossRefPubMed

30.

de Cuba EM, Verwaal VJ, de Hingh IH et al (2014) Morbidity associated with colostomy reversal after cytoreductive surgery and HIPEC. Ann Surg Oncol 21(3):883–890CrossRefPubMed

Title: Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Authors: H. Jacoby
Y. Berger
L. Barda
N. Sharif
Y. Zager
A. Lebedyev
M. Gutman
A. Hoffman
Publication date: 01-07-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4450-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2018

Measuring Outcomes of Clinical Care: Victorian Emergency Laparotomy Audit Using Quality Investigator

The Value of the C-Reactive Protein-to-Albumin Ratio is Useful for Predicting Survival of Patients with Child–Pugh Class A Undergoing Liver Resection for Hepatocellular Carcinoma

Preoperative Watchful–Waiting Time and Surgical Outcome of Patients with Non-small Cell Lung Cancer Found by Chest Low-Dose CT Screening

The Association of Preoperative Hematocrit and Transfusion with Mortality in Patients Undergoing Elective Non-cardiac Surgery

American College of Surgeons Member Involvement in Global Surgery: Results from the 2015 Operation Giving Back Survey

One-Hour Postoperative Parathyroid Hormone Levels Do Not Reliably Predict Hypocalcemia After Thyroidectomy