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Prognostic Factors and Significance of Gastrointestinal Leak After Cytoreductive Surgery (CRS) with Heated Intraperitoneal Chemotherapy (HIPEC)

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

Abstract

Background

Gastrointestinal leak (GIL) after cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) is associated with significant morbidity and mortality. This study aimed to identify GIL prognostic factors and its impact on overall survival.

Methods

A retrospective analysis of a prospectively maintained database comprising 1270 CRS/HIPEC procedures was performed. Type of GIL, functional and resection status, morbidity, mortality, and survival were reviewed.

Results

Gastrointestinal leaks were identified in 8.7% (110/1270) of CRS/HIPEC procedures, including 53 anastomotic leaks (4.2%), 53 hollow viscus perforations (4.2%), and four leaks at unknown sites. The multivariate predictors of leak were Eastern Cooperative Oncology Group (ECOG) functional status (ECOG 1 vs. 0: odds ratio [OR] 2.12, p = 0.009; ECOG 2 vs. 0: OR 2.90, p = 0.004), and number of anastomoses (OR 5.34; p < 0.0001). The in-hospital mortality rate for the GIL cohort was 21.8% (24/110), with a 72% (80/110) reoperation rate. The leak cohort had a higher major morbidity rate (88.3 vs. 23.3%; p < 0.0001), a longer hospital stay (39.0 vs. 9.9 days; p < 0.0001), and a longer intensive care unit (ICU) stay (7.7 vs. 1.7 days; p = 0.0003). After surgical mortality was excluded, the overall survival periods for the leak and no-leak patients with complete cytoreduction were respectively 1.5 and 4.98 years (p = 0.0001). Clinically significant decreases in survival were observed for all primary malignancies.

Conclusions

Gastrointestinal leak after CRS/HIPEC is a source of significant mortality, with a decrease in overall survival even after complete CRS. Preoperative functional status and number of anastomoses are predictors of leak for CRS/HIPEC patients.

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Acknowledgement

This study was supported by Wake Forest University Biostatistics shared resource NCI CCSG P30CA012197.

Disclosure

There are no conflicts of interest.

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Authors and Affiliations

  1. Surgical Oncology Service, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA

    Konstantinos Chouliaras MD, Edward A. Levine MD, Perry Shen MD & Konstantinos I. Votanopoulos MD, PhD

  2. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Nora Fino MS

Authors
  1. Konstantinos Chouliaras MD
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  2. Edward A. Levine MD
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  3. Nora Fino MS
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  4. Perry Shen MD
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  5. Konstantinos I. Votanopoulos MD, PhD
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Corresponding author

Correspondence to Konstantinos I. Votanopoulos MD, PhD.

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Chouliaras, K., Levine, E.A., Fino, N. et al. Prognostic Factors and Significance of Gastrointestinal Leak After Cytoreductive Surgery (CRS) with Heated Intraperitoneal Chemotherapy (HIPEC). Ann Surg Oncol 24, 890–897 (2017). https://doi.org/10.1245/s10434-016-5738-6

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  • DOI: https://doi.org/10.1245/s10434-016-5738-6

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