TY - JOUR
T1 - Institutional Experience with Ostomies Created During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion
AU - Pakraftar, Sam
AU - Ramalingam, Lekshmi
AU - Shuai, Yongli
AU - Jones, Heather L.
AU - Pingpank, James F.
AU - Ahrendt, Steven S.
AU - Holtzman, Matthew P.
AU - Zureikat, Amer H.
AU - Zeh, Herbert J.
AU - Bartlett, David L.
AU - Choudry, Haroon A.
N1 - Funding Information:
The project was supported by the National Institutes of Health through grant no. UL1-TR-001857 using a Red cap maintained database. This work was also partially funded by generous support from Valarie Koch and the New Era Cap Company. None
Funding Information:
ACKNOWLEGMENT The project was supported by the National Institutes of Health through grant no. UL1-TR-001857 using a Red cap maintained database. This work was also partially funded by generous support from Valarie Koch and the New Era Cap Company.
Publisher Copyright:
© 2017, Society of Surgical Oncology.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - 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. 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. 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. 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.
AB - 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. 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. 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. 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.
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U2 - 10.1245/s10434-017-6114-x
DO - 10.1245/s10434-017-6114-x
M3 - Article
C2 - 29019111
AN - SCOPUS:85030852058
SN - 1068-9265
VL - 24
SP - 3811
EP - 3817
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 13
ER -