title: Stoma Creation and Reversal After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy.
abstract: BACKGROUND
  Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) often includes stoma creation. We evaluated the indications, morbidity, and mortality associated with stoma creation and reversal after CRS/HIPEC.
  
  
  METHODS
  Retrospective analysis of a prospective database of 1149 CRS-HIPEC procedures was performed. Patient demographics, type of malignancy, comorbidities, Clavien-graded morbidity, mortality, indications for stoma creation, and outcomes of subsequent reversal were abstracted.
  
  
  RESULTS
  Sixteen percent (186/1149) of CRS/HIPEC procedures included stoma creation, whereas 1.1 % (11/963) of patients without initial stoma creation developed anastomotic leaks requiring stoma. Patients who required a stoma had worse preoperative performance status (ECOG 0/1: 77.2 vs. 86.1 %, p = 0.002), greater burden of disease (PCI 17.6 vs. 12.9, p < 0.0001), and were more likely to have R2 resections (74.5 vs. 48.8 %, p < 0.0001) than those without stoma creation. Stomas were intended to be permanent in 17.5 % (35/199). Of 164 patients with potentially reversible ostomies, only 26.2 % (43/164) underwent reversal. Disease progression (43/164, 26.2 %) and death (40/164, 24.3 %) most commonly precluded reversal. After reversal, 27.9 % (12/43) suffered a Clavien I/II morbidity, 27.9 % (12/43) suffered Clavien III/IV morbidity, and 30-day mortality was 4.7 % (2/43). Anastomotic leak occurred after 9 % (3/33) of ileostomy and 10 % (1/10) of colostomy reversals.
  
  
  CONCLUSIONS
  Stomas are more common among CRS/HIPEC patients with a high burden of disease and poor functional status. Reversal is uncommon and is associated with significant major morbidity. Preoperative counseling for those with high disease burden and poor functional status should include the risk of permanent stoma.
authors.affiliation: Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, 27157, USA. adoud@wakehealth.edu.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Doud
authors.affiliation: Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, 27157, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, USA.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.affiliation: Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, 27157, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Stewart
authors.affiliation: Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, 27157, USA.
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.affiliation: Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, 27157, USA. kvotanop@wakehealth.edu.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Votanopoulos
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D054048:Peritoneal Stomata / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor