L. M. Cohen1, J. Baumgartner1, J. Veerapong1, A. Lowy1, K. J. Kelly1 1University Of California – San Diego,Surgical Oncology,San Diego, CA, USA
Introduction: There is currently no consensus on when stoma creation for temporary fecal diversion is indicated during cytoreduction and hyperthermic intrapertioneal chemotherapy (CRS/HIPEC). The aim of this study was to evaluate the indications for and outcomes following fecal diversion in CRS/HIPEC at a high volume center where stoma creation is used infrequently.
Methods: A retrospective review of a prospectively maintained database of patients with peritoneal surface malignancy was performed to identify those who underwent complete CRS/HIPEC between 2007 and 2017.
Results: Of 416 patients who underwent complete CRS/HIPEC during the time period, 226 had at least one bowel resection and anastomosis and were included in the analysis. In total, 17 patients (8%) had a stoma created at the time of CRS/HIPEC. Six (3%) had end colostomy and 11 (5%) had ileostomy meant for temporary fecal diversion. All patients with ileostomy creation underwent proctectomy. Additional factors associated with ileostomy creation included: Body mass index (BMI), prior systemic chemotherapy, operative time, and peritoneal carcinomatosis index (PCI) (Table). In all patients and in the subset that underwent low anterior resection (LAR) (n = 38), there were no differences in anastomotic leak rate (0% vs 3%, p=0.543), inpatient morbidity (64% vs 65%, p=0.945), or length of stay (median 11 days in both groups, p=0.926), but 60-day readmission rate was higher in patients with ileostomy (55% versus 25%, p=0.031). All patients with ileostomy underwent reversal. The median time to reversal was 98 days (range 62 to 567).
Conclusion: The main indication for diverting ileostomy in CRS/HIPEC was LAR. Diverting ileostomy was not associated with decreased anastomotic leak rate when considering all patients or the subset of patients that underwent LAR, but was associated with increased rates of 60-day readmission. These data suggest that the use of temporary fecal diversion in CRS/HIPEC is rarely required, including in patients who undergo LAR.
