Institutional Experience with Ostomies Created During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion

Sam Pakraftar, Lekshmi Ramalingam, Yongli Shuai, Heather L. Jones, James F. Pingpank, Steven S. Ahrendt, Matthew P. Holtzman, Amer H. Zureikat, Herbert J. Zeh, David L. Bartlett, Haroon A. Choudry

Research output: Contribution to journalArticle

4 Scopus citations

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. 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.

Original languageEnglish (US)
Pages (from-to)3811-3817
Number of pages7
JournalAnnals of Surgical Oncology
Volume24
Issue number13
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Pakraftar, S., Ramalingam, L., Shuai, Y., Jones, H. L., Pingpank, J. F., Ahrendt, S. S., Holtzman, M. P., Zureikat, A. H., Zeh, H. J., Bartlett, D. L., & Choudry, H. A. (2017). Institutional Experience with Ostomies Created During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion. Annals of Surgical Oncology, 24(13), 3811-3817. https://doi.org/10.1245/s10434-017-6114-x