Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
H. Jacoby, Y. Berger, L. Barda, N. Sharif, Y. Zager, A. Lebedyev, M. Gutman, A. Hoffman*
Background: Formation of protective stoma as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) may be an effective tool in reducing anastomotic leak incidence. Our aim was to evaluate the incidence and implications of stoma formation during CRS–HIPEC and to examine whether a creation of protective stoma reduces the postoperative morbidity. Methods: A cohort retrospective analysis of all CRS–HIPEC procedures performed between 2004 and 2016 was conducted. Predicting factors for stoma formation were assessed by comparing all patients who underwent stoma formation to those who did not; both groups were then restricted to cases with ≥2 bowel anastomoses and compared in terms of perioperative outcomes in order to determine whether protective stoma confers a morbidity benefit. Results: One hundred and ninety-nine CRS–HIPEC procedures were performed on 186 patients. Thirty-four patients (17%) underwent stoma formation, 24 of them as protective stoma. Formation of a stoma was correlated with higher peritoneal carcinomatosis index score (13.6 ± 8 vs. 9.5 ± 7.7, p = 0.007), larger number of organs resected (p < 0.001), greater number of anastomoses (p < 0.001), prolonged operative time (8.1 ± 2.7 vs. 6.6 ± 2.2 h, p = 0.002), and prolonged hospital stay (12 vs. 8.5 days, p = 0.001). In procedures requiring ≥2 anastomoses, formation of protective stoma reduced the anastomotic leak rate (6 vs. 37%, p = 0.025), the morbidity rate (6 vs. 41%, p = 0.017), and reoperation rate (0 vs. 28%, p = 0.03). Overall, 15 patients (44%) underwent stoma reversal, 3 of whom had a complication treated non-operatively. Conclusions: Protective stoma should be considered in extensive CRS–HIPEC procedures requiring two or more bowel anastomoses in order to reduce the postoperative morbidity rate.
World Journal of Surgery
Published - 1 Jul 2018
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Cytoreduction Surgical Procedures Medicine & Life Sciences 100%
Induced Hyperthermia Medicine & Life Sciences 93%
Anastomotic Leak Medicine & Life Sciences 36%
Peritoneal Neoplasms Medicine & Life Sciences 20%
Incidence Medicine & Life Sciences 15%
Operative Time Medicine & Life Sciences 14%
Reoperation Medicine & Life Sciences 14%
Jacoby, H., Berger, Y., Barda, L., Sharif, N., Zager, Y., Lebedyev, A., Gutman, M., & Hoffman, A. (2018). Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World Journal of Surgery, 42(7), 2036-2042. https://doi.org/10.1007/s00268-017-4450-4
Jacoby, H. ; Berger, Y. ; Barda, L. et al. / Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. In: World Journal of Surgery. 2018 ; Vol. 42, No. 7. pp. 2036-2042.
@article{21158ddede5e4ef98434ee1902a45f43,
title = "Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy",
abstract = "Background: Formation of protective stoma as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) may be an effective tool in reducing anastomotic leak incidence. Our aim was to evaluate the incidence and implications of stoma formation during CRS–HIPEC and to examine whether a creation of protective stoma reduces the postoperative morbidity. Methods: A cohort retrospective analysis of all CRS–HIPEC procedures performed between 2004 and 2016 was conducted. Predicting factors for stoma formation were assessed by comparing all patients who underwent stoma formation to those who did not; both groups were then restricted to cases with ≥2 bowel anastomoses and compared in terms of perioperative outcomes in order to determine whether protective stoma confers a morbidity benefit. Results: One hundred and ninety-nine CRS–HIPEC procedures were performed on 186 patients. Thirty-four patients (17%) underwent stoma formation, 24 of them as protective stoma. Formation of a stoma was correlated with higher peritoneal carcinomatosis index score (13.6 ± 8 vs. 9.5 ± 7.7, p = 0.007), larger number of organs resected (p < 0.001), greater number of anastomoses (p < 0.001), prolonged operative time (8.1 ± 2.7 vs. 6.6 ± 2.2 h, p = 0.002), and prolonged hospital stay (12 vs. 8.5 days, p = 0.001). In procedures requiring ≥2 anastomoses, formation of protective stoma reduced the anastomotic leak rate (6 vs. 37%, p = 0.025), the morbidity rate (6 vs. 41%, p = 0.017), and reoperation rate (0 vs. 28%, p = 0.03). Overall, 15 patients (44%) underwent stoma reversal, 3 of whom had a complication treated non-operatively. Conclusions: Protective stoma should be considered in extensive CRS–HIPEC procedures requiring two or more bowel anastomoses in order to reduce the postoperative morbidity rate.",
author = "H. Jacoby and Y. Berger and L. Barda and N. Sharif and Y. Zager and A. Lebedyev and M. Gutman and A. Hoffman",
note = "Publisher Copyright: {\textcopyright} 2018, Soci{\'e}t{\'e} Internationale de Chirurgie.",
journal = "World Journal of Surgery",
Jacoby, H, Berger, Y, Barda, L, Sharif, N, Zager, Y, Lebedyev, A, Gutman, M & Hoffman, A 2018, 'Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy', World Journal of Surgery, vol. 42, no. 7, pp. 2036-2042. https://doi.org/10.1007/s00268-017-4450-4
Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. / Jacoby, H.; Berger, Y.; Barda, L. et al.
In: World Journal of Surgery, Vol. 42, No. 7, 01.07.2018, p. 2036-2042.
T1 - Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
AU - Jacoby, H.
AU - Berger, Y.
AU - Barda, L.
AU - Sharif, N.
AU - Zager, Y.
AU - Lebedyev, A.
AU - Gutman, M.
AU - Hoffman, A.
N1 - Publisher Copyright: © 2018, Société Internationale de Chirurgie.
N2 - Background: Formation of protective stoma as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) may be an effective tool in reducing anastomotic leak incidence. Our aim was to evaluate the incidence and implications of stoma formation during CRS–HIPEC and to examine whether a creation of protective stoma reduces the postoperative morbidity. Methods: A cohort retrospective analysis of all CRS–HIPEC procedures performed between 2004 and 2016 was conducted. Predicting factors for stoma formation were assessed by comparing all patients who underwent stoma formation to those who did not; both groups were then restricted to cases with ≥2 bowel anastomoses and compared in terms of perioperative outcomes in order to determine whether protective stoma confers a morbidity benefit. Results: One hundred and ninety-nine CRS–HIPEC procedures were performed on 186 patients. Thirty-four patients (17%) underwent stoma formation, 24 of them as protective stoma. Formation of a stoma was correlated with higher peritoneal carcinomatosis index score (13.6 ± 8 vs. 9.5 ± 7.7, p = 0.007), larger number of organs resected (p < 0.001), greater number of anastomoses (p < 0.001), prolonged operative time (8.1 ± 2.7 vs. 6.6 ± 2.2 h, p = 0.002), and prolonged hospital stay (12 vs. 8.5 days, p = 0.001). In procedures requiring ≥2 anastomoses, formation of protective stoma reduced the anastomotic leak rate (6 vs. 37%, p = 0.025), the morbidity rate (6 vs. 41%, p = 0.017), and reoperation rate (0 vs. 28%, p = 0.03). Overall, 15 patients (44%) underwent stoma reversal, 3 of whom had a complication treated non-operatively. Conclusions: Protective stoma should be considered in extensive CRS–HIPEC procedures requiring two or more bowel anastomoses in order to reduce the postoperative morbidity rate.
AB - Background: Formation of protective stoma as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) may be an effective tool in reducing anastomotic leak incidence. Our aim was to evaluate the incidence and implications of stoma formation during CRS–HIPEC and to examine whether a creation of protective stoma reduces the postoperative morbidity. Methods: A cohort retrospective analysis of all CRS–HIPEC procedures performed between 2004 and 2016 was conducted. Predicting factors for stoma formation were assessed by comparing all patients who underwent stoma formation to those who did not; both groups were then restricted to cases with ≥2 bowel anastomoses and compared in terms of perioperative outcomes in order to determine whether protective stoma confers a morbidity benefit. Results: One hundred and ninety-nine CRS–HIPEC procedures were performed on 186 patients. Thirty-four patients (17%) underwent stoma formation, 24 of them as protective stoma. Formation of a stoma was correlated with higher peritoneal carcinomatosis index score (13.6 ± 8 vs. 9.5 ± 7.7, p = 0.007), larger number of organs resected (p < 0.001), greater number of anastomoses (p < 0.001), prolonged operative time (8.1 ± 2.7 vs. 6.6 ± 2.2 h, p = 0.002), and prolonged hospital stay (12 vs. 8.5 days, p = 0.001). In procedures requiring ≥2 anastomoses, formation of protective stoma reduced the anastomotic leak rate (6 vs. 37%, p = 0.025), the morbidity rate (6 vs. 41%, p = 0.017), and reoperation rate (0 vs. 28%, p = 0.03). Overall, 15 patients (44%) underwent stoma reversal, 3 of whom had a complication treated non-operatively. Conclusions: Protective stoma should be considered in extensive CRS–HIPEC procedures requiring two or more bowel anastomoses in order to reduce the postoperative morbidity rate.
JO - World Journal of Surgery
JF - World Journal of Surgery
Jacoby H, Berger Y, Barda L, Sharif N, Zager Y, Lebedyev A et al. Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World Journal of Surgery. 2018 Jul 1;42(7):2036-2042. doi: 10.1007/s00268-017-4450-4