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

Jason T. Wiseman, Charles Kimbrough, Eliza W. Beal, Mohammad Y. Zaidi, Charles A. Staley, Travis Grotz, Jennifer Leiting, Keith Fournier, Andrew J. Lee, Sean Dineen, Benjamin Powers, Jula Veerapong, Joel M. Baumgartner, Callisia Clarke, Sameer H. Patel, Vikrom Dhar, Ryan J. Hendrix, Laura Lambert, Daniel E. Abbott, Courtney PokrzywaMustafa Raoof, Byrne Lee, Nadege Fackche, Jonathan Greer, Timothy M. Pawlik, Sherif Abdel-Misih, Jordan M. Cloyd

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)783-792
Number of pages10
JournalAnnals of surgical oncology
Volume27
Issue number3
DOIs
StateAccepted/In press - Jan 1 2019

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Drug Therapy
Appendiceal Neoplasms
Anastomotic Leak
Mortality
Reoperation
Fistula
Length of Stay
Neoplasms
Histology
Odds Ratio
Morbidity
Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Wiseman, J. T., Kimbrough, C., Beal, E. W., Zaidi, M. Y., Staley, C. A., Grotz, T., ... Cloyd, J. M. (Accepted/In press). Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Technique Matter? Annals of surgical oncology, 27(3), 783-792. https://doi.org/10.1245/s10434-019-07964-x

Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy : Does Technique Matter? / Wiseman, Jason T.; Kimbrough, Charles; Beal, Eliza W.; Zaidi, Mohammad Y.; Staley, Charles A.; Grotz, Travis; Leiting, Jennifer; Fournier, Keith; Lee, Andrew J.; Dineen, Sean; Powers, Benjamin; Veerapong, Jula; Baumgartner, Joel M.; Clarke, Callisia; Patel, Sameer H.; Dhar, Vikrom; Hendrix, Ryan J.; Lambert, Laura; Abbott, Daniel E.; Pokrzywa, Courtney; Raoof, Mustafa; Lee, Byrne; Fackche, Nadege; Greer, Jonathan; Pawlik, Timothy M.; Abdel-Misih, Sherif; Cloyd, Jordan M.

In: Annals of surgical oncology, Vol. 27, No. 3, 01.03.2020, p. 783-792.

Research output: Contribution to journalArticle

Wiseman, JT, Kimbrough, C, Beal, EW, Zaidi, MY, Staley, CA, Grotz, T, Leiting, J, Fournier, K, Lee, AJ, Dineen, S, Powers, B, Veerapong, J, Baumgartner, JM, Clarke, C, Patel, SH, Dhar, V, Hendrix, RJ, Lambert, L, Abbott, DE, Pokrzywa, C, Raoof, M, Lee, B, Fackche, N, Greer, J, Pawlik, TM, Abdel-Misih, S & Cloyd, JM 2020, 'Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Technique Matter?', Annals of surgical oncology, vol. 27, no. 3, pp. 783-792. https://doi.org/10.1245/s10434-019-07964-x
Wiseman, Jason T. ; Kimbrough, Charles ; Beal, Eliza W. ; Zaidi, Mohammad Y. ; Staley, Charles A. ; Grotz, Travis ; Leiting, Jennifer ; Fournier, Keith ; Lee, Andrew J. ; Dineen, Sean ; Powers, Benjamin ; Veerapong, Jula ; Baumgartner, Joel M. ; Clarke, Callisia ; Patel, Sameer H. ; Dhar, Vikrom ; Hendrix, Ryan J. ; Lambert, Laura ; Abbott, Daniel E. ; Pokrzywa, Courtney ; Raoof, Mustafa ; Lee, Byrne ; Fackche, Nadege ; Greer, Jonathan ; Pawlik, Timothy M. ; Abdel-Misih, Sherif ; Cloyd, Jordan M. / Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy : Does Technique Matter?. In: Annals of surgical oncology. 2020 ; Vol. 27, No. 3. pp. 783-792.
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title = "Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Technique Matter?",
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.",
author = "Wiseman, {Jason T.} and Charles Kimbrough and Beal, {Eliza W.} and Zaidi, {Mohammad Y.} and Staley, {Charles A.} and Travis Grotz and Jennifer Leiting and Keith Fournier and Lee, {Andrew J.} and Sean Dineen and Benjamin Powers and Jula Veerapong and Baumgartner, {Joel M.} and Callisia Clarke and Patel, {Sameer H.} and Vikrom Dhar and Hendrix, {Ryan J.} and Laura Lambert and Abbott, {Daniel E.} and Courtney Pokrzywa and Mustafa Raoof and Byrne Lee and Nadege Fackche and Jonathan Greer and Pawlik, {Timothy M.} and Sherif Abdel-Misih and Cloyd, {Jordan M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1245/s10434-019-07964-x",
language = "English (US)",
volume = "27",
pages = "783--792",
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TY - JOUR

T1 - Predictors of Anastomotic Failure After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

T2 - Does Technique Matter?

AU - Wiseman, Jason T.

AU - Kimbrough, Charles

AU - Beal, Eliza W.

AU - Zaidi, Mohammad Y.

AU - Staley, Charles A.

AU - Grotz, Travis

AU - Leiting, Jennifer

AU - Fournier, Keith

AU - Lee, Andrew J.

AU - Dineen, Sean

AU - Powers, Benjamin

AU - Veerapong, Jula

AU - Baumgartner, Joel M.

AU - Clarke, Callisia

AU - Patel, Sameer H.

AU - Dhar, Vikrom

AU - Hendrix, Ryan J.

AU - Lambert, Laura

AU - Abbott, Daniel E.

AU - Pokrzywa, Courtney

AU - Raoof, Mustafa

AU - Lee, Byrne

AU - Fackche, Nadege

AU - Greer, Jonathan

AU - Pawlik, Timothy M.

AU - Abdel-Misih, Sherif

AU - Cloyd, Jordan M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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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