Primary Anastomosis versus Ostomy after Colon Resection during Debulking of Ovarian Carcinomatosis: A NSQIP Analysis.
Ovarian carcinomatosis poses a dilemma for the surgeon. When resecting colon for tumor invasion, one must decide between diversion and primary anastomosis (PA). We examined the National Surgical Quality Improvement Program to determine whether PA associated with more complications than ostomy. The National Surgical Quality Improvement Program dataset was queried for patients with ovarian carcinomatosis between 2007 and 2012. Current Procedural Terminology codes were used to further identify patients undergoing colectomy with PA or ostomy. Logistic regression was used to evaluate 30-day morbidity and mortality. The 1013 ovarian carcinomatosis patients who underwent elective colon surgery were divided into primary repair (n = 453, 43.5%) or ostomy (n = 586, 56.5%) groups. Preoperative demographics were similar; however, ostomy patients had more severe preoperative laboratory derangements. The 30-day mortality and postoperative transfusion requirements were higher in the ostomy group. On multivariate analysis controlling for confounders, the differences were no longer significant. In conclusion, 30-day mortality and postoperative complications were increased in the ostomy group. Given the laboratory derangements in this group, this may reflect tendency to allocate ostomies to more ill patients. Primary repair in a selected population does not worsen outcomes. Prospective evaluation would help determine the impact of PA in the ovarian carcinomatosis population.
Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Vidya A
VA
Fleetwood
John C
JC
Kubasiak
Imke
I
Janssen
Jonathan A
JA
Myers
Keith W
KW
Millikan
Daniel J
DJ
Deziel
Minh B
MB
Luu
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D003082:Colectomy; D003110:Colonic Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D065426:Cytoreduction Surgical Procedures; D016208:Databases, Factual; D004766:Enterostomy; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery; D016015:Logistic Models; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome