Morbidity associated with colostomy reversal after cytoreductive surgery and HIPEC.
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.
Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands, e.decuba@vumc.nl.
Erienne M V
EM
de Cuba
Victor J
VJ
Verwaal
Ignace H J T
IH
de Hingh
Leonieke J J
LJ
van Mens
Simon W
SW
Nienhuijs
Arend G J
AG
Aalbers
Hendrik J
HJ
Bonjer
Elisabeth A
EA
te Velde
D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies