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The impact of gastrointestinal anastomotic leaks on survival of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy.
- Source :
-
American journal of surgery [Am J Surg] 2022 Feb; Vol. 223 (2), pp. 331-338. Date of Electronic Publication: 2021 Apr 01. - Publication Year :
- 2022
-
Abstract
- Background: Gastrointestinal (GI) leaks after cytoreductive surgery and hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) is a known life-threatening complication that may alter patients' outcomes. Our aim is to investigate risk factors associated with GI leaks and evaluate the impact of GI leaks on patient's oncological outcomes.<br />Methods: A retrospective analysis of perioperative and oncological outcomes of patients with and without GI leaks after CRS/HIPEC.<br />Results: Out of 191 patients included in this study, GI leaks were identified in 17.8% (34/191) of patients. Small bowel anastomoses were the most common site (44%). Most of the GI leaks were managed conservatively and re-operation was needed in 44.1% of cases. Univariate analysis identified higher PCI (p = 0.03), higher number of packed cells transfused (p = 0.036), pelvic peritonectomy (p = 0.013), high number of anastomoses (p = 0.003) and colonic resection (p = 0.042) as factors associated with GI leaks. Multivariate analysis identified stapled anastomoses (OR 2.59, p = 0.001) and pelvic peritonectomy (OR 2.33, p = 0.044) as independent factors associated with GI leaks. Disease-free survival tended to be worse in the leak group but did not reach statistical significance (p = 0.235). The 3- and 5-year OS was 73.2% and 52.9% in the leak group compared to 75.8% and 73.2% in the non-leak group (p = 0.236).<br />Conclusions: GI leak showed no impact on overall and disease free survival after CRS/HIPEC.Avoidance of stapled reconstruction in high risk patients with high tumor burden and large number of anastomoses may yield improved outcomes.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Anastomotic Leak epidemiology
Anastomotic Leak etiology
Anastomotic Leak therapy
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Combined Modality Therapy
Cytoreduction Surgical Procedures adverse effects
Humans
Retrospective Studies
Survival Rate
Hyperthermia, Induced adverse effects
Percutaneous Coronary Intervention adverse effects
Peritoneal Neoplasms
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1883
- Volume :
- 223
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- American journal of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 33832737
- Full Text :
- https://doi.org/10.1016/j.amjsurg.2021.03.061