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Safe Anastomoses without Ostomies in Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy: Technical Considerations and Modifications

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Gastrointestinal complications, predominantly anastomotic leak (AL), are the most frequent source of severe morbidity after cytoreductive surgery (CRS).

Objective

The aim of this study was to present the technical standards for colorectal anastomoses developed and systematically applied to all patients undergoing CRS in a high-volume tertiary center, and the associated AL rates.

Methods

This was a descriptive study reporting the technical characteristics of a standardized protocol for three types of colorectal anastomoses (colorectal, ileorectal, and ileocolic) in CRS with heated intraperitoneal chemotherapy (HIPEC), and a retrospective analysis of prospectively collected data on anastomotic outcomes. All patients (1172) undergoing CRS with HIPEC from September 2006 to September 2020 were included. The anastomotic complications were classified according to the International Study Group of Rectal Cancer Surgery (ISGRCS) classification.

Results

Overall, 1172 patients underwent 1300 procedures and 1359 gastrointestinal anastomoses. An ileocolic anastomosis was performed in 408 patients, colorectal anastomosis in 469 patients, and ileorectal anastomosis in 16 patients, none with diverting ileostomy; 345 other gastrointestinal reconstructions and 82 urinary reconstructions were performed in these patients. The AL rate was 1% (4/408) for the ileocolic anastomosis, 0.85% (4/469) for the colorectal anastomosis, and 0% (0/16) for the ileorectal anastomosis. One patient died postoperatively due to AL.

Conclusions

Systematic application of standardized techniques adapted to ensure optimal tissue healing (stapled anastomoses avoiding overlap, accurate staple deployment, and hand-sewn reinforcement) are associated with a very high level of anastomotic safety in a large cohort of patients undergoing CRS and HIPEC.

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Authors and Affiliations

  1. Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain

    Pedro Barrios MD, PhD, Isabel Ramos MD, Oriol Crusellas MD, Domenico Sabia MD & Lana Bijelic MD

  2. Colorectal Surgery Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain

    Sergio Mompart MD

Authors
  1. Pedro Barrios MD, PhD
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  2. Isabel Ramos MD
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  3. Oriol Crusellas MD
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  4. Domenico Sabia MD
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  6. Lana Bijelic MD
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Correspondence to Lana Bijelic MD.

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Pedro Barrios, Isabel Ramos, Oriol Crusellas, Domenico Sabia, Sergio Mompart, and Lana Bijelic declare no conflicts of interest.

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Barrios, P., Ramos, I., Crusellas, O. et al. Safe Anastomoses without Ostomies in Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy: Technical Considerations and Modifications. Ann Surg Oncol 28, 7784–7792 (2021). https://doi.org/10.1245/s10434-021-09842-x

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  • DOI: https://doi.org/10.1245/s10434-021-09842-x

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