title: Risk of definitive stoma after surgery for peritoneal malignancy in 958 patients: comparative study between complete cytoreductive surgery and maximal tumor debulking.
abstract: BACKGROUND
  Complete cytoreductive surgery (CRS) can achieve cure or long-term survival in selected patients with peritoneal malignancy. In selected patients, due to extensive disease, complete tumour removal is impossible and optimal strategy may be maximal tumour debulking (MTD). We analysed the stoma related outcome in a series of patients undergoing surgery in a National Peritoneal Malignancy Referral Centre.
  
  
  METHODS
  All patients who underwent CRS, with or without, intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) between 1994 and 2012 were included. Data was collected prospectively in an institutional database and analysed retrospectively.
  
  
  RESULTS
  CRS was performed in 958 patients (female: 595, male: 363) of whom 781 (81.5%) had a primary appendix tumour, 63 (6.6%) had a colorectal primary, 47 (4.9%) peritoneal mesothelioma, 38 (4%) an ovarian tumour and 29 patients (3%) other tumours. Complete CRS was achieved in 72% (693/958). Overall 352/958 (37%) had a stoma, which was permanent in 165/958 (17.2%). The median time interval from CRS to reversal of stoma was 4.4 months (range: 1.4-13.8). Stomas were created in 113/265 (42.6%) at MTD (permanent: n = 105 (93%), temporary: n = 8 (7%)), and 239/693 (34.5%) at complete CRS (permanent: n = 60 (25%), temporary: n = 179 (75%)) (p = 0.020). All temporary stomas in the 168/693 (24.4%) of patients who had complete CRS were subsequently reversed.
  
  
  CONCLUSIONS
  To achieve complete CRS for peritoneal malignancy a stoma is often required and in a proportion this will be permanent. Overall over one third had a stoma at surgery with almost half subsequently reversed.
authors.affiliation: Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, UK.
authors.forename: S
authors.initials: S
authors.lastname: Riss
authors.affiliation: Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, UK.
authors.forename: K
authors.initials: K
authors.lastname: Chandrakumaran
authors.affiliation: Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, UK.
authors.forename: S
authors.initials: S
authors.lastname: Dayal
authors.affiliation: Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, UK.
authors.forename: T D
authors.initials: TD
authors.lastname: Cecil
authors.affiliation: Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, UK.
authors.forename: F
authors.initials: F
authors.lastname: Mohamed
authors.affiliation: Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, UK. Electronic address: Brendan.Moran@hhft.nhs.uk.
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001063:Appendiceal Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003125:Colostomy / Q000706:statistics & numerical data*; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007081:Ileostomy / Q000706:statistics & numerical data*; D007263:Infusions, Parenteral / Q000379:methods; D008297:Male; D008654:Mesothelioma / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology*; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D011553:Pseudomyxoma Peritonei / Q000188:drug therapy / Q000601:surgery*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Complication; HIPEC; Ileostomy; Peritoneal malignancy; Pseudomyxoma peritonei; Stoma reversal