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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2020

01-03-2020 | Surgery | Peritoneal Surface Malignancy

Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Technique Matter?

Authors: Jason T. Wiseman, MD, MSPH, Charles Kimbrough, MD, Eliza W. Beal, MD, Mohammad Y. Zaidi, MD, MS, Charles A. Staley, MD, Travis Grotz, MD, Jennifer Leiting, MD, Keith Fournier, MD, Andrew J. Lee, MD, Sean Dineen, MD, Benjamin Powers, MD, Jula Veerapong, MD, Joel M. Baumgartner, MD, MAS, Callisia Clarke, MD, Sameer H. Patel, MD, Vikrom Dhar, MD, Ryan J. Hendrix, MD, Laura Lambert, MD, Daniel E. Abbott, MD, Courtney Pokrzywa, MD, Mustafa Raoof, MD, Byrne Lee, MD, Nadege Fackche, MD, Jonathan Greer, MD, Timothy M. Pawlik, MD, MPH, PhD, Sherif Abdel-Misih, MD, Jordan M. Cloyd, MD

Published in: Annals of Surgical Oncology | Issue 3/2020

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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.
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Metadata
Title
Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Technique Matter?
Authors
Jason T. Wiseman, MD, MSPH
Charles Kimbrough, MD
Eliza W. Beal, MD
Mohammad Y. Zaidi, MD, MS
Charles A. Staley, MD
Travis Grotz, MD
Jennifer Leiting, MD
Keith Fournier, MD
Andrew J. Lee, MD
Sean Dineen, MD
Benjamin Powers, MD
Jula Veerapong, MD
Joel M. Baumgartner, MD, MAS
Callisia Clarke, MD
Sameer H. Patel, MD
Vikrom Dhar, MD
Ryan J. Hendrix, MD
Laura Lambert, MD
Daniel E. Abbott, MD
Courtney Pokrzywa, MD
Mustafa Raoof, MD
Byrne Lee, MD
Nadege Fackche, MD
Jonathan Greer, MD
Timothy M. Pawlik, MD, MPH, PhD
Sherif Abdel-Misih, MD
Jordan M. Cloyd, MD
Publication date
01-03-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07964-x

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