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Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Technique Matter?

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Anastomotic failure (AF) after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) remains a dreaded complication. Whether specific factors, including anastomotic technique, are associated with AF is poorly understood.

Methods

Patients who underwent CRS-HIPEC including at least one bowel resection between 2000 and 2017 from 12 academic institutions were reviewed to determine factors associated with AF (anastomotic leak or enteric fistula).

Results

Among 1020 patients who met the inclusion criteria, the median age was 55 years, 43.9% were male, and the most common histology was appendiceal neoplasm (62.3%). The median Peritoneal Cancer Index was 14, and 93.2% of the patients underwent CC0/1 resection. Overall, 82 of the patients (8%) experienced an AF, whereas 938 (92.0%) did not. In the multivariable analysis, the factors associated with AF included male gender (odds ratio [OR], 2.2; p < 0.01), left-sided colorectal resection (OR 10.0; p = 0.03), and preoperative albumin (OR 1.8 per g/dL; p = 0.02).Technical factors such as method (stapled vs hand-sewn), timing of anastomosis, and chemotherapy regimen used were not associated with AF (all p > 0.05). Anastomotic failure was associated with longer hospital stay (23 vs 10 days; p < 0.01), higher complication rate (90% vs 59%; p < 0.01), higher reoperation rate (41% vs 9%; p < 0.01), more 30-day readmissions (59% vs 22%; p < 0.01), greater 30-day mortality (9% vs 1%; p < 0.01), and greater 90-day mortality (16% vs 8%; p = 0.02) as well as shorter median overall survival (25.6 vs 66.0 months; p < 0.01).

Conclusions

Among patients undergoing CRS-HIPEC, AF is independently associated with postoperative morbidity and worse long-term outcomes. Because patient- and tumor-related, but not technical, factors are associated with AF, operative technique may be individualized based on patient considerations and surgeon preference.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Jason T. Wiseman MD, MSPH, Charles Kimbrough MD, Eliza W. Beal MD, Timothy M. Pawlik MD, MPH, PhD, Sherif Abdel-Misih MD & Jordan M. Cloyd MD

  2. Department of Surgery, Emory University, Atlanta, GA, USA

    Mohammad Y. Zaidi MD, MS & Charles A. Staley MD

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Travis Grotz MD & Jennifer Leiting MD

  4. Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA

    Keith Fournier MD & Andrew J. Lee MD

  5. Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Sean Dineen MD & Benjamin Powers MD

  6. Department of Surgery, University of California, San Diego, San Diego, CA, USA

    Jula Veerapong MD & Joel M. Baumgartner MD, MAS

  7. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Callisia Clarke MD

  8. Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA

    Sameer H. Patel MD & Vikrom Dhar MD

  9. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Ryan J. Hendrix MD

  10. Department of Surgery, Huntsman Cancer Institute, Salt Lake City, UT, USA

    Laura Lambert MD

  11. Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA

    Daniel E. Abbott MD & Courtney Pokrzywa MD

  12. Department of Surgery, City of Hope Cancer Center, Duarte, CA, USA

    Mustafa Raoof MD & Byrne Lee MD

  13. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA

    Nadege Fackche MD & Jonathan Greer MD

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  1. Jason T. Wiseman MD, MSPH
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Correspondence to Jordan M. Cloyd MD.

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Wiseman, J.T., Kimbrough, C., Beal, E.W. et al. Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Technique Matter?. Ann Surg Oncol 27, 783–792 (2020). https://doi.org/10.1245/s10434-019-07964-x

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