Peritoneal Surface Malignancies Unit Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Fellow from Department of General Surgery, São João University Hospital Center, Porto, Portugal; Medical Faculty, University of Porto, Porto, Portugal.
Peritoneal Surface Malignancies Unit Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Fellow from University Putra Malaysia, Malaysia.
Eur J Surg Oncol. 2023 Oct;49(10):107020. doi: 10.1016/j.ejso.2023.107020. Epub 2023 Aug 14.
Gastrointestinal leak is one of the most feared complications after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) and harbors significant postoperative morbidity and mortality. We aim to identify risk-factors for anastomotic leak (AL) and gastrointestinal perforation (GP) to optimize postoperative outcomes of this population.
We performed a retrospective analysis of 1043 consecutive patients submitted to CRS in a single institution. Potential risk factors for AL and GP, both related to patient overall condition, disease status and surgical technique were reviewed.
Anastomotic leaks were identified in 5.2% of patients, and GPs in 7.0%. The independent risk-factors for AL were age at surgery (OR1.40; CI95% 1.10-1.79); peritoneal cancer index (PCI) (OR1.04, CI95% 1.01-1.07); Cisplatin dose >240 mg during HIPEC (OR3.53; CI95% 1.47-8.56) and the presence of colorectal (CR) or colo-colic (CC) anastomosis (OR5.09; CI95% 2.71-9.53, and 4.58; CI95% 1.22-17.24 respectively). Male gender and intraoperative red blood cell transfusions were the only independent risk factors for GP identified (OR1.70; CI95% 1.04-2.78 and 1.06; CI95% 1.01-1.12, respectively). Regarding 30-day and 90-day postoperative mortality, independent risk-factors were mainly related to patient's overall condition.
Gastrointestinal leaks are a frequent source of postoperative morbidity, mainly at the expense of GP. A careful and systematic intraoperative revision of all potential gastrointestinal injuries is equally critical to perfecting anastomotic fashioning techniques to decrease gastrointestinal complication rates. We identified multiple risk-factors for AL and GP related to disease status and patient condition. Our study suggests that patient-related conditions are of paramount relevance, highlighting the importance of patient selection and preoperative patient optimization.
胃肠道漏是细胞减灭术联合腹腔内热灌注化疗（CRS-HIPEC）后最可怕的并发症之一，可导致显著的术后发病率和死亡率。我们旨在确定吻合口漏（AL）和胃肠道穿孔（GP）的风险因素，以优化该人群的术后结果。
我们对单中心的 1043 例连续接受 CRS 的患者进行了回顾性分析。评估了与患者整体状况、疾病状态和手术技术相关的 AL 和 GP 的潜在风险因素。
5.2%的患者发生吻合口漏，7.0%的患者发生 GP。AL 的独立危险因素为手术时年龄（OR1.40；95%CI95%为 1.10-1.79）；腹膜癌指数（PCI）（OR1.04，95%CI95%为 1.01-1.07）；HIPEC 期间顺铂剂量>240mg（OR3.53；95%CI95%为 1.47-8.56）和存在结直肠（CR）或结肠-结肠（CC）吻合（OR5.09；95%CI95%为 2.71-9.53 和 4.58；95%CI95%为 1.22-17.24）。男性和术中红细胞输血是唯一确定的 GP 独立危险因素（OR1.70；95%CI95%为 1.04-2.78 和 1.06；95%CI95%为 1.01-1.12）。关于 30 天和 90 天术后死亡率，独立危险因素主要与患者的整体状况有关。
胃肠道漏是术后发病率的常见原因，主要是胃肠道穿孔所致。术中仔细、系统地检查所有潜在的胃肠道损伤对于完善吻合技术以降低胃肠道并发症发生率至关重要。我们确定了与疾病状态和患者状况相关的 AL 和 GP 的多个风险因素。我们的研究表明，与患者相关的情况至关重要，突出了患者选择和术前患者优化的重要性。
