Department of Surgery, The Ohio State University, Columbus, OH, USA.
Department of Surgery, Emory University, Atlanta, GA, USA.
Ann Surg Oncol. 2020 Mar;27(3):783-792. doi: 10.1245/s10434-019-07964-x. Epub 2019 Oct 28.
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.
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).
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).
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.
细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）后的吻合口失败（AF）仍然是一种可怕的并发症。是否存在包括吻合技术在内的特定因素与 AF 有关，目前还知之甚少。
回顾了 2000 年至 2017 年期间，来自 12 个学术机构的至少进行了一次肠切除术的接受 CRS-HIPEC 治疗的患者，以确定与 AF（吻合口漏或肠瘘）相关的因素。
在符合纳入标准的 1020 名患者中，中位年龄为 55 岁，43.9%为男性，最常见的组织学类型为阑尾肿瘤（62.3%）。中位腹膜癌指数为 14，93.2%的患者行 CC0/1 切除术。总的来说，82 名患者（8%）发生了 AF，938 名患者（92.0%）没有。多变量分析显示，与 AF 相关的因素包括男性（比值比 [OR]，2.2；p<0.01）、左半结直肠切除术（OR，10.0；p=0.03）和术前白蛋白（OR，每克/dL 增加 1.8；p=0.02）。吻合技术（吻合器吻合与手工吻合）、吻合口时间和化疗方案等技术因素与 AF 无关（均 p>0.05）。AF 与住院时间延长（23 天 vs 10 天；p<0.01）、并发症发生率升高（90% vs 59%；p<0.01）、再次手术率升高（41% vs 9%；p<0.01）、30 天再入院率升高（59% vs 22%；p<0.01）、30 天死亡率升高（9% vs 1%；p<0.01）和 90 天死亡率升高（16% vs 8%；p=0.02）以及中位总生存期缩短（25.6 个月 vs 66.0 个月；p<0.01）有关。
在接受 CRS-HIPEC 治疗的患者中，AF 与术后发病率和较差的长期预后独立相关。由于与患者和肿瘤相关的因素而不是技术因素与 AF 相关，因此可以根据患者的情况和外科医生的偏好来个体化手术技术。
