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Safety of rectum anastomosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Author(s) -
Breitenbuch Philipp,
Piso Pompiliu,
Schlitt Hans J
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25189
Subject(s) - rectum , medicine , anastomosis , surgery , ileostomy , hyperthermic intraperitoneal chemotherapy , abdominoperineal resection , colorectal surgery , cytoreductive surgery , general surgery , colorectal cancer , abdominal surgery , cancer , ovarian cancer
Background and Objectives In highly selected patients with peritoneal carcinomatosis, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can be an aggressive but worthwhile treatment regimen. Resection of the rectosigmoid is frequently performed with CRS. The aim of the study was to assess the safety of the rectal anastomosis in this setting. Methods Between 2005 and 2016, 436 patients underwent CRS/HIPEC. Clinical data were analyzed with respect to the morbidity associated with a rectum resection. Results In 436 patients, 174 rectum resections (40%) were performed with CRS, including 149 anterior resections of the rectosigmoid, 23 low anterior rectum resections, and 2 abdominoperineal rectum excisions. A total of 141 rectum anastomoses were performed; 33 patients received a permanent ostomy, and 48 patients received a protective ileostomy. After changing the operation technique of the rectum anastomosis, the number of protective ileostomies decreased from 65% to 20%. The overall postoperative morbidity was 31%. Rectal anastomotic leakages were seen in only 5% of cases. Conclusions Anastomotic leakages of the rectum are rarely seen after CRS/HIPEC. HIPEC performed immediately after surgery seems to have no negative effect on the rectum anastomosis. Performing rectum anastomoses after CRS/ HIPEC appears to be a safe procedure.