Back to Search
Start Over
Institutional Experience with Ostomies Created During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion.
- Source :
-
Annals of surgical oncology [Ann Surg Oncol] 2017 Dec; Vol. 24 (13), pp. 3811-3817. Date of Electronic Publication: 2017 Oct 10. - Publication Year :
- 2017
-
Abstract
- Background: Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC) is a complex procedure that often requires ostomy creation to protect high-risk anastomoses. This study aimed to evaluate the authors' institutional experience with CRS-HIPEC-associated ostomies, determine predictors of ostomy creation and reversal, and assess their impact on survival.<br />Methods: The study analyzed clinicopathologic, perioperative, and oncologic data from a prospective database of 1435 CRS-HIPEC procedures for peritoneal metastases. The Kaplan-Meier method was used to estimate survival. Multivariate analyses identified associations with ostomy creation/reversal and survival.<br />Results: Ostomies were created in 34% of the patients, most commonly loop ileostomies (82%). Loop ileostomies were reversed in the majority of patients (83%), whereas non-loop ileostomies were infrequently reversed (< 10% reversal rate). In a multivariate logistic regression model, intermediate or high tumor grade, colectomy/proctectomy, longer operative time, and lower Charlson comorbidity index were associated with loop ileostomy creation, whereas incomplete macroscopic resection, colorectal histology, and major postoperative complications were associated with non-reversal of loop ileostomy. In a multivariate Cox proportional hazards model, intermediate or high tumor grade and non-reversal of loop ileostomy were associated with worse overall survival.<br />Conclusions: Loop ileostomies were almost always reversed, whereas non-loop ileostomies were almost always permanent. Hospital readmissions for loop ileostomy-related complications were common. Therefore, formal outpatient protocols for prevention and management should be implemented. Non-reversal of loop ileostomy was associated with very poor survival.
- Subjects :
- Chemotherapy, Adjuvant
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Peritoneal Neoplasms secondary
Peritoneal Stomata
Prognosis
Prospective Studies
Retrospective Studies
Survival Rate
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Chemotherapy, Cancer, Regional Perfusion
Cytoreduction Surgical Procedures
Hyperthermia, Induced
Ostomy methods
Peritoneal Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1534-4681
- Volume :
- 24
- Issue :
- 13
- Database :
- MEDLINE
- Journal :
- Annals of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 29019111
- Full Text :
- https://doi.org/10.1245/s10434-017-6114-x