Mor Eyal, Assaf Dan, Laks Shachar, Benvenisti Haggai, Ben-Yaacov Almog, Zohar Nitzan, Schtrechman Gal, Hazzan David, Shacham-Shmueli Einat, Perelson Daria, Adileh Mohammad, Nissan Aviram
The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; Affiliated with the Sackler School of Medicine, Tel Aviv University, Israel.
The Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel; Affiliated with the Sackler School of Medicine, Tel Aviv University, Israel.
Am J Surg. 2022 Feb;223(2):331-338. doi: 10.1016/j.amjsurg.2021.03.061. Epub 2021 Apr 1.
Gastrointestinal (GI) leaks after cytoreductive surgery and hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) is a known life-threatening complication that may alter patients' outcomes. Our aim is to investigate risk factors associated with GI leaks and evaluate the impact of GI leaks on patient's oncological outcomes.
A retrospective analysis of perioperative and oncological outcomes of patients with and without GI leaks after CRS/HIPEC.
Out of 191 patients included in this study, GI leaks were identified in 17.8% (34/191) of patients. Small bowel anastomoses were the most common site (44%). Most of the GI leaks were managed conservatively and re-operation was needed in 44.1% of cases. Univariate analysis identified higher PCI (p = 0.03), higher number of packed cells transfused (p = 0.036), pelvic peritonectomy (p = 0.013), high number of anastomoses (p = 0.003) and colonic resection (p = 0.042) as factors associated with GI leaks. Multivariate analysis identified stapled anastomoses (OR 2.59, p = 0.001) and pelvic peritonectomy (OR 2.33, p = 0.044) as independent factors associated with GI leaks. Disease-free survival tended to be worse in the leak group but did not reach statistical significance (p = 0.235). The 3- and 5-year OS was 73.2% and 52.9% in the leak group compared to 75.8% and 73.2% in the non-leak group (p = 0.236).
GI leak showed no impact on overall and disease free survival after CRS/HIPEC.Avoidance of stapled reconstruction in high risk patients with high tumor burden and large number of anastomoses may yield improved outcomes.
减瘤手术及热灌注化疗（CRS/HIPEC）后发生胃肠道（GI）漏是一种已知的危及生命的并发症，可能会改变患者的预后。我们的目的是研究与胃肠道漏相关的危险因素，并评估胃肠道漏对患者肿瘤学预后的影响。
对接受CRS/HIPEC后发生或未发生胃肠道漏的患者的围手术期及肿瘤学预后进行回顾性分析。
本研究纳入的191例患者中，17.8%（34/191）的患者发生了胃肠道漏。小肠吻合口是最常见的部位（44%）。大多数胃肠道漏通过保守治疗，44.1%的病例需要再次手术。单因素分析确定较高的PCI（p = 0.03）、较高的红细胞输注量（p = 0.036）、盆腔腹膜切除术（p = 0.013）、较多的吻合口数量（p = 0.003）和结肠切除术（p = 0.042）是与胃肠道漏相关的因素。多因素分析确定吻合器吻合（OR 2.59，p = 0.001）和盆腔腹膜切除术（OR 2.33，p = 0.044）是与胃肠道漏相关的独立因素。漏组的无病生存期倾向于更差，但未达到统计学意义（p = 0.235）。漏组的3年和5年总生存率分别为73.2%和52.9%，而非漏组分别为75.8%和73.2%（p = 0.236）。
胃肠道漏对CRS/HIPEC后的总生存期和无病生存期无影响。对于肿瘤负荷高且吻合口数量多的高危患者，避免使用吻合器重建可能会改善预后。
