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Bowel Anastomosis After or Before HIPEC: A Comparative Study in Patients Undergoing CRS+HIPEC for Peritoneal Surface Malignancy

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

Abstract

Background

Anastomotic leak after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) remains a dreaded complication. There is no consensus statement regarding the optimal timing for bowel anastomoses to perform after or before HIPEC.

Methods

Patients who underwent CRS+HIPEC and had at least one bowel anastomosis were retrospectively analyzed to evaluate if timing of anastomosis done after or before HIPEC had an impact on bowel complication rates (anastomotic leak and perforation).

Results

From 2013 to 2019, 214 of 370 patients underwent CRS+HIPEC and had at least one bowel anastomosis. Of these 214 patients, 104 and 110 patients had anastomosis after and before HIPEC, respectively. A total of 324 anastomoses were performed, with a mean of 0.87 anastomoses per patient (range 1–4). The incidence of anastomotic leaks was comparable between the pre- and post-HIPEC groups (3.6% vs. 4.8%; p > 0.05), as was the bowel complication rate (7.6% vs. 7.2%). After multivariate analysis, prior surgical score >1 (odds ratio [OR] 4.3), recurrent cancers (OR 7.4), and more than two anastomosis (OR 3.8) were considered independent risk factors for bowel complications.

Conclusion

Anastomosis of the bowel performed after or before HIPEC does not affect bowel complication rates (leak/perforation). Higher prior surgical score, surgery for recurrent cancers, and more than two bowel anastomosis are independent risk factors for predicting bowel complications. Prehabilitation, standardization of steps, immediate attention and repair of serosal tears, and thorough inspection of the bowel before closure helps to decrease bowel complications. The timing of anastomosis can be at the discretion of the surgeon.

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Acknowledgment

The authors thank the patients and study teams involved in the study. They also thank Med ONE Pharma Solutions, Guru Gram, Delhi NCR, India, for medical writing support for the development of the manuscript. Medical writing support was only used for the outlay of the manuscript, as suggested by the authors, and for English language and grammar.

Funding

No sources of funding were used to assist in the preparation of this study.

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Authors and Affiliations

  1. Manipal Comprehensive Cancer Centre, Manipal Hospital, Bangalore, India

    S. P. Somashekhar MCh (Oncosurgery) FRCS Ed., Kumar C. Rohit, Yethadka Ramya, Shabber S. Zaveri MCh (Oncosurgery), Vijay Ahuja MD OBG & K. R. Ashwin

  2. Department of Data Science, Alke Research Private Limited, Bengaluru, India

    Arun Kumar Namachivayam PhD, (Biostatistics)

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  1. S. P. Somashekhar MCh (Oncosurgery) FRCS Ed.
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Correspondence to Kumar C. Rohit.

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S.P. Somashekhar, Kumar C. Rohit, Yethadka Ramya, Shabber S. Zaveri, Vijay Ahuja, Arun Kumar Namachivayam, and K.R. Ashwin have no conflicts of interest to declare.

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Somashekhar, S.P., Rohit, K.C., Ramya, Y. et al. Bowel Anastomosis After or Before HIPEC: A Comparative Study in Patients Undergoing CRS+HIPEC for Peritoneal Surface Malignancy. Ann Surg Oncol 29, 214–223 (2022). https://doi.org/10.1245/s10434-021-10661-3

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