Morbidity associated with colostomy reversal after cytoreductive surgery and HIPEC
(2014) In Annals of Surgical Oncology 21(3). p.90-883- Abstract
BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has improved the survival in selected colorectal cancer patients with peritoneal metastases. In these patients, the risk of a low anastomosis is sometimes diminished through the creation of a colostomy. Currently, the morbidity and mortality associated with the reversal of the colostomy in this population is unknown.
METHODS: Our study involved two prospectively collected databases including all patients who underwent CRS-HIPEC. We identified all consecutive patients who had a colostomy and requested a reversal. The associations between four clinical and ten treatment-related factors with the outcome of the reversal procedure were... (More)
BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has improved the survival in selected colorectal cancer patients with peritoneal metastases. In these patients, the risk of a low anastomosis is sometimes diminished through the creation of a colostomy. Currently, the morbidity and mortality associated with the reversal of the colostomy in this population is unknown.
METHODS: Our study involved two prospectively collected databases including all patients who underwent CRS-HIPEC. We identified all consecutive patients who had a colostomy and requested a reversal. The associations between four clinical and ten treatment-related factors with the outcome of the reversal procedure were determined by univariate analysis.
RESULTS: 21 of 336 patients (6.3 %) with a stoma with a mean age of 50.8 (standard deviation 10.2) years underwent a reversal procedure. One patient was classified as American Society of Anesthesiologists (ASA) grade III, 6 as ASA grade II, and the remaining as ASA grade I. Median time elapsed between HIPEC and reversal was 394 days (range 133-1194 days). No life-threatening complications or mortality were observed after reversal. The reversal-related morbidity was 67 %. Infectious complications were observed in 7 patients (33 %). Infectious complications after HIPEC were negatively correlated with the ultimate restoration of bowel continuity (P = 0.05). Bowel continuity was successfully restored in 71 % of the patients.
CONCLUSIONS: Although the restoration of bowel continuity after CRS-HIPEC was successful in most patients, a relatively high complication rate was observed. Patients with infectious complications after HIPEC have a diminished chance of successful restoration of bowel continuity.
(Less)
- author
- de Cuba, Erienne M V ; Verwaal, Victor J LU ; de Hingh, Ignace H J T ; van Mens, Leonieke J J ; Nienhuijs, Simon W ; Aalbers, Arend G J ; Bonjer, Hendrik J and te Velde, Elisabeth A
- publishing date
- 2014-03
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adult, Aged, Chemotherapy, Adjuvant, Chemotherapy, Cancer, Regional Perfusion/adverse effects, Colostomy/adverse effects, Female, Follow-Up Studies, Humans, Hyperthermia, Induced/adverse effects, Male, Middle Aged, Morbidity, Neoplasm Grading, Neoplasm Staging, Neoplasms/pathology, Peritoneal Neoplasms/secondary, Postoperative Complications/etiology, Prognosis, Prospective Studies
- in
- Annals of Surgical Oncology
- volume
- 21
- issue
- 3
- pages
- 90 - 883
- publisher
- Springer
- external identifiers
-
- scopus:84896725238
- pmid:24242680
- ISSN
- 1534-4681
- DOI
- 10.1245/s10434-013-3370-2
- language
- English
- LU publication?
- no
- id
- 1e6b940b-d53d-4bdf-857b-f177062a79cc
- date added to LUP
- 2022-04-05 11:13:57
- date last changed
- 2024-06-27 13:29:17
@article{1e6b940b-d53d-4bdf-857b-f177062a79cc,
abstract = {{<p>BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has improved the survival in selected colorectal cancer patients with peritoneal metastases. In these patients, the risk of a low anastomosis is sometimes diminished through the creation of a colostomy. Currently, the morbidity and mortality associated with the reversal of the colostomy in this population is unknown.</p><p>METHODS: Our study involved two prospectively collected databases including all patients who underwent CRS-HIPEC. We identified all consecutive patients who had a colostomy and requested a reversal. The associations between four clinical and ten treatment-related factors with the outcome of the reversal procedure were determined by univariate analysis.</p><p>RESULTS: 21 of 336 patients (6.3 %) with a stoma with a mean age of 50.8 (standard deviation 10.2) years underwent a reversal procedure. One patient was classified as American Society of Anesthesiologists (ASA) grade III, 6 as ASA grade II, and the remaining as ASA grade I. Median time elapsed between HIPEC and reversal was 394 days (range 133-1194 days). No life-threatening complications or mortality were observed after reversal. The reversal-related morbidity was 67 %. Infectious complications were observed in 7 patients (33 %). Infectious complications after HIPEC were negatively correlated with the ultimate restoration of bowel continuity (P = 0.05). Bowel continuity was successfully restored in 71 % of the patients.</p><p>CONCLUSIONS: Although the restoration of bowel continuity after CRS-HIPEC was successful in most patients, a relatively high complication rate was observed. Patients with infectious complications after HIPEC have a diminished chance of successful restoration of bowel continuity.</p>}},
author = {{de Cuba, Erienne M V and Verwaal, Victor J and de Hingh, Ignace H J T and van Mens, Leonieke J J and Nienhuijs, Simon W and Aalbers, Arend G J and Bonjer, Hendrik J and te Velde, Elisabeth A}},
issn = {{1534-4681}},
keywords = {{Adult; Aged; Chemotherapy, Adjuvant; Chemotherapy, Cancer, Regional Perfusion/adverse effects; Colostomy/adverse effects; Female; Follow-Up Studies; Humans; Hyperthermia, Induced/adverse effects; Male; Middle Aged; Morbidity; Neoplasm Grading; Neoplasm Staging; Neoplasms/pathology; Peritoneal Neoplasms/secondary; Postoperative Complications/etiology; Prognosis; Prospective Studies}},
language = {{eng}},
number = {{3}},
pages = {{90--883}},
publisher = {{Springer}},
series = {{Annals of Surgical Oncology}},
title = {{Morbidity associated with colostomy reversal after cytoreductive surgery and HIPEC}},
url = {{http://dx.doi.org/10.1245/s10434-013-3370-2}},
doi = {{10.1245/s10434-013-3370-2}},
volume = {{21}},
year = {{2014}},
}