Abstract
Introduction
Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) often includes stoma creation. We evaluated the indications, morbidity, and mortality associated with stoma creation and reversal after CRS/HIPEC.
Methods
Retrospective analysis of a prospective database of 1149 CRS–HIPEC procedures was performed. Patient demographics, type of malignancy, comorbidities, Clavien-graded morbidity, mortality, indications for stoma creation, and outcomes of subsequent reversal were abstracted.
Results
Sixteen percent (186/1149) of CRS/HIPEC procedures included stoma creation, whereas 1.1 % (11/963) of patients without initial stoma creation developed anastomotic leaks requiring stoma. Patients who required a stoma had worse preoperative performance status (ECOG 0/1: 77.2 vs. 86.1 %, p = 0.002), greater burden of disease (PCI 17.6 vs. 12.9, p < 0.0001), and were more likely to have R2 resections (74.5 vs. 48.8 %, p < 0.0001) than those without stoma creation. Stomas were intended to be permanent in 17.5 % (35/199). Of 164 patients with potentially reversible ostomies, only 26.2 % (43/164) underwent reversal. Disease progression (43/164, 26.2 %) and death (40/164, 24.3 %) most commonly precluded reversal. After reversal, 27.9 % (12/43) suffered a Clavien I/II morbidity, 27.9 % (12/43) suffered Clavien III/IV morbidity, and 30-day mortality was 4.7 % (2/43). Anastomotic leak occurred after 9 % (3/33) of ileostomy and 10 % (1/10) of colostomy reversals.
Conclusions
Stomas are more common among CRS/HIPEC patients with a high burden of disease and poor functional status. Reversal is uncommon and is associated with significant major morbidity. Preoperative counseling for those with high disease burden and poor functional status should include the risk of permanent stoma.
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Acknowledgment
The authors thank the support of the Biostatistics and Bioinformatics Shared Resource, Comprehensive Cancer Center of Wake Forest University and NCI Cancer Center Support Grant P30 CA012197. Supported by: Wake Forest University Biostatistics shared resource NCI CCSG P30CA012197.
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Accepted for oral presentation at 10th International Symposium on Regional Cancer Therapies, Clearwater, FL Feb 2015 and 10th Annual Academic Surgical Congress, Las Vegas, NV, Feb 2015.
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Doud, A.N., Levine, E.A., Fino, N.F. et al. Stoma Creation and Reversal After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 23, 503–510 (2016). https://doi.org/10.1245/s10434-015-4674-1
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DOI: https://doi.org/10.1245/s10434-015-4674-1