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01-03-2014 | Gastrointestinal Oncology

Morbidity Associated with Colostomy Reversal After Cytoreductive Surgery and HIPEC

Authors: Erienne M. V. de Cuba, MD, Victor J. Verwaal, MD, PhD, Ignace H. J. T. de Hingh, MD, PhD, Leonieke J. J. van Mens, BSc, Simon W. Nienhuijs, MD, PhD, Arend G. J. Aalbers, MD, Hendrik J. Bonjer, MD, PhD, Elisabeth A. te Velde, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2014

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has improved the survival in selected colorectal cancer patients with peritoneal metastases. In these patients, the risk of a low anastomosis is sometimes diminished through the creation of a colostomy. Currently, the morbidity and mortality associated with the reversal of the colostomy in this population is unknown.

Methods

Our study involved two prospectively collected databases including all patients who underwent CRS–HIPEC. We identified all consecutive patients who had a colostomy and requested a reversal. The associations between four clinical and ten treatment-related factors with the outcome of the reversal procedure were determined by univariate analysis.

Results

21 of 336 patients (6.3 %) with a stoma with a mean age of 50.8 (standard deviation 10.2) years underwent a reversal procedure. One patient was classified as American Society of Anesthesiologists (ASA) grade III, 6 as ASA grade II, and the remaining as ASA grade I. Median time elapsed between HIPEC and reversal was 394 days (range 133–1194 days). No life-threatening complications or mortality were observed after reversal. The reversal-related morbidity was 67 %. Infectious complications were observed in 7 patients (33 %). Infectious complications after HIPEC were negatively correlated with the ultimate restoration of bowel continuity (P = 0.05). Bowel continuity was successfully restored in 71 % of the patients.

Conclusions

Although the restoration of bowel continuity after CRS–HIPEC was successful in most patients, a relatively high complication rate was observed. Patients with infectious complications after HIPEC have a diminished chance of successful restoration of bowel continuity.

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Title: Morbidity Associated with Colostomy Reversal After Cytoreductive Surgery and HIPEC
Authors: Erienne M. V. de Cuba, MD
Victor J. Verwaal, MD, PhD
Ignace H. J. T. de Hingh, MD, PhD
Leonieke J. J. van Mens, BSc
Simon W. Nienhuijs, MD, PhD
Arend G. J. Aalbers, MD
Hendrik J. Bonjer, MD, PhD
Elisabeth A. te Velde, MD, PhD
Publication date: 01-03-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 3/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-3370-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Morbidity Associated with Colostomy Reversal After Cytoreductive Surgery and HIPEC

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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