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

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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.

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Acknowledgements

All authors contributed to the publication of the study.

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Authors and Affiliations

  1. Department of Surgery and Transplantation, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel Hashomer, Ramat Gan, Israel

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

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  1. H. Jacoby
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  2. Y. Berger
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  3. L. Barda
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  4. N. Sharif
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  5. Y. Zager
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  6. A. Lebedyev
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  7. M. Gutman
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  8. A. Hoffman
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Correspondence to A. Hoffman.

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Jacoby, H., Berger, Y., Barda, L. et al. Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World J Surg 42, 2036–2042 (2018). https://doi.org/10.1007/s00268-017-4450-4

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  • DOI: https://doi.org/10.1007/s00268-017-4450-4

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