The impact of ostomy creation after cytoreduction and hyperthermic intraperitoneal chemotherapy in a newly established peritoneal malignancy program

Zachary E. Stiles, Nathan M. Hinkle, Gitonga Munene, Paxton V. Dickson, Andrew M. Davidoff, Jeremiah Deneve

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Abstract

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has improved outcomes for selected patients with peritoneal carcinomatosis and often requires ostomy creation. We examined the impact of ostomy creation in a newly established peritoneal malignancy program. A retrospective review was performed of CRS-HIPEC procedures from 2011 to 2016. Those who did and did not receive an ostomy were compared. Fifty-eight patients underwent CRS-HIPEC and an ostomy was created in 25.9 per cent. Median peritoneal cancer index (14 vs 16, P 5 0.63) and multivisceral resection rates (87.9 vs 100.0%, P 5 0.17) were similar between groups. Multivariable analysis revealed that bowel resection (OR 210.65, P 5 0.02) was significantly associated with ostomy creation. Advanced age was noted to be inversely associated with stoma formation (OR 0.04, P 5 0.04). Progression-free survival was significantly lower in the ostomy group (18 vs 23 months, P 5 0.03). Those with an ostomy experienced prolonged length of stay (13.3 6 7.4 vs 9.5 6 3.7, P 5 0.01). At follow-up, 6/10 temporary ostomies had undergone reversal and three patients experienced morbidity after reversal. Ostomy creation may occur during CRS-HIPEC and carries potential for morbidity. Ostomy creation may contribute to postoperative length of stay. Patients should be counseled preoperatively on the potential impact of ostomy placement during CRS-HIPEC.

Original languageEnglish (US)
Pages (from-to)783-788
Number of pages6
JournalAmerican Surgeon
Volume84
Issue number6
StatePublished - Jun 1 2018

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Ostomy
Drug Therapy
Neoplasms
Length of Stay
Morbidity
Disease-Free Survival

All Science Journal Classification (ASJC) codes

  • Surgery

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The impact of ostomy creation after cytoreduction and hyperthermic intraperitoneal chemotherapy in a newly established peritoneal malignancy program. / Stiles, Zachary E.; Hinkle, Nathan M.; Munene, Gitonga; Dickson, Paxton V.; Davidoff, Andrew M.; Deneve, Jeremiah.

In: American Surgeon, Vol. 84, No. 6, 01.06.2018, p. 783-788.

Research output: Contribution to journalArticle

Stiles, Zachary E. ; Hinkle, Nathan M. ; Munene, Gitonga ; Dickson, Paxton V. ; Davidoff, Andrew M. ; Deneve, Jeremiah. / The impact of ostomy creation after cytoreduction and hyperthermic intraperitoneal chemotherapy in a newly established peritoneal malignancy program. In: American Surgeon. 2018 ; Vol. 84, No. 6. pp. 783-788.
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abstract = "Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has improved outcomes for selected patients with peritoneal carcinomatosis and often requires ostomy creation. We examined the impact of ostomy creation in a newly established peritoneal malignancy program. A retrospective review was performed of CRS-HIPEC procedures from 2011 to 2016. Those who did and did not receive an ostomy were compared. Fifty-eight patients underwent CRS-HIPEC and an ostomy was created in 25.9 per cent. Median peritoneal cancer index (14 vs 16, P 5 0.63) and multivisceral resection rates (87.9 vs 100.0{\%}, P 5 0.17) were similar between groups. Multivariable analysis revealed that bowel resection (OR 210.65, P 5 0.02) was significantly associated with ostomy creation. Advanced age was noted to be inversely associated with stoma formation (OR 0.04, P 5 0.04). Progression-free survival was significantly lower in the ostomy group (18 vs 23 months, P 5 0.03). Those with an ostomy experienced prolonged length of stay (13.3 6 7.4 vs 9.5 6 3.7, P 5 0.01). At follow-up, 6/10 temporary ostomies had undergone reversal and three patients experienced morbidity after reversal. Ostomy creation may occur during CRS-HIPEC and carries potential for morbidity. Ostomy creation may contribute to postoperative length of stay. Patients should be counseled preoperatively on the potential impact of ostomy placement during CRS-HIPEC.",
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