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Rectal anastomosis and hyperthermic intraperitoneal chemotherapy: Should we avoid diverting loop ileostomy?
Alexandre Brind'Amour1, Vera Pravong2, Lucas Sidéris3
1Department of Surgery, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.
Summary
A diverting loop ileostomy may prevent rectal anastomotic leaks after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). However, it increases readmission rates and carries a risk of leaks after stoma reversal.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Rectal anastomosis following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) presents unique challenges.
- Limited literature exists on the safety and morbidity of rectal anastomoses with or without fecal diversion in this patient population.
Purpose of the Study:
- To assess the safety and morbidity of rectal anastomoses during CRS and HIPEC.
- To evaluate the impact of diverting loop ileostomy on rectal anastomotic complications.
Main Methods:
- Retrospective chart review of 84 patients undergoing CRS and HIPEC requiring rectal anastomosis.
- Comparison of outcomes between patients with and without a diverting loop ileostomy.
Main Results:
- The overall rectal anastomotic leak rate was 8.3%.
- Diverting loop ileostomy significantly decreased clinically significant rectal anastomotic leaks (0% vs 12.7%).
- Patients with ileostomy had higher 90-day readmission rates (37.9% vs 10.9%) and a 10.7% leak rate after stoma reversal.
Conclusions:
- Diverting loop ileostomy may be an effective strategy to prevent symptomatic rectal anastomotic leaks after CRS with HIPEC.
- This approach is associated with increased readmission rates and a risk of leaks upon stoma reversal.
