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Is Fecal Diversion Needed in Pelvic Anastomoses During Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 25 May 2017

Abstract

Background

The role of fecal diversion with pelvic anastomosis during cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is not well defined.

Methods

A retrospective review of patients who underwent CRS and HIPEC between 2009 and 2016 was performed to identify those with a pelvic anastomosis (colorectal, ileorectal, or coloanal anastomosis).

Results

The study identified 73 patients who underwent CRS and HIPEC at three different institutions between July 2009 and June of 2016. Of these patients, 32 (44%) underwent a primary anastomosis with a diverting ileostomy, whereas 41 (56%) underwent a primary anastomosis without fecal diversion. The anastomotic leak rate for the no-diversion group was 22% compared with 0% for the group with a diverting ileostomy (p < 0.01). The 90-day mortality rate for the no-diversion group was 7.1%. The hospital stay was 14.1 ± 8.0 days in the diversion group compared with 17.9 ± 12.5 days in the no-diversion group (p = 0.12). Of those patients with a diverting ileostomy, 68% (n = 22) had their bowel continuity restored, 18% of which required a laparotomy for reversal. Postoperative complications occurred for 50% of those who required a laparotomy and for 44% of those who did not require a laparotomy (p = 0.84).

Conclusion

Diverting ileostomies in patients with a pelvic anastomosis undergoing CRS and HIPEC are associated with a significantly reduced anastomotic leak rate. Reversal of the diverting ileostomy in this patient population required a laparotomy in 18% of the cases and had an associated morbidity rate of 50%.

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Authors and Affiliations

  1. Department of Surgery, University of California Irvine, Orange, CA, USA

    Matthew D. Whealon MD, John V. Gahagan MD, Sarath Sujatha-Bhaskar MD & Alessio Pigazzi MD, PhD

  2. Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

    Michael P. O’Leary MD, Sinziana Dumitra MD & Byrne Lee MD

  3. Department of Surgery, Loma Linda University, Loma Linda, CA, USA

    Matthew Selleck DO & Maheswari Senthil MD

Authors
  1. Matthew D. Whealon MD
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  2. John V. Gahagan MD
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  9. Alessio Pigazzi MD, PhD
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Correspondence to Alessio Pigazzi MD, PhD.

Additional information

The original version of this article was revised: Sarath Sujatha-Bhaskar’s family name was misspelled.

An erratum to this article is available at http://dx.doi.org/10.1245/s10434-017-5893-4.

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Whealon, M.D., Gahagan, J.V., Sujatha-Bhaskar, S. et al. Is Fecal Diversion Needed in Pelvic Anastomoses During Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?. Ann Surg Oncol 24, 2122–2128 (2017). https://doi.org/10.1245/s10434-017-5853-z

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