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| [PMID]: | 26077915 |
| [Au] Autor: | Doud AN; Levine EA; Fino NF; Stewart JH; Shen P; Votanopoulos KI |
| [Ad] Endereço: | Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, 27157, USA. adoud@wakehealth.edu. |
| [Ti] Título: | Stoma Creation and Reversal After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. |
| [So] Source: | Ann Surg Oncol;23(2):503-10, 2016 Feb. | | [Is] ISSN: | 1534-4681 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | INTRODUCTION: Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) often includes stoma creation. We evaluated the indications, morbidity, and mortality associated with stoma creation and reversal after CRS/HIPEC. METHODS: Retrospective analysis of a prospective database of 1149 CRS-HIPEC procedures was performed. Patient demographics, type of malignancy, comorbidities, Clavien-graded morbidity, mortality, indications for stoma creation, and outcomes of subsequent reversal were abstracted. RESULTS: Sixteen percent (186/1149) of CRS/HIPEC procedures included stoma creation, whereas 1.1 % (11/963) of patients without initial stoma creation developed anastomotic leaks requiring stoma. Patients who required a stoma had worse preoperative performance status (ECOG 0/1: 77.2 vs. 86.1 %, p = 0.002), greater burden of disease (PCI 17.6 vs. 12.9, p < 0.0001), and were more likely to have R2 resections (74.5 vs. 48.8 %, p < 0.0001) than those without stoma creation. Stomas were intended to be permanent in 17.5 % (35/199). Of 164 patients with potentially reversible ostomies, only 26.2 % (43/164) underwent reversal. Disease progression (43/164, 26.2 %) and death (40/164, 24.3 %) most commonly precluded reversal. After reversal, 27.9 % (12/43) suffered a Clavien I/II morbidity, 27.9 % (12/43) suffered Clavien III/IV morbidity, and 30-day mortality was 4.7 % (2/43). Anastomotic leak occurred after 9 % (3/33) of ileostomy and 10 % (1/10) of colostomy reversals. CONCLUSIONS: Stomas are more common among CRS/HIPEC patients with a high burden of disease and poor functional status. Reversal is uncommon and is associated with significant major morbidity. Preoperative counseling for those with high disease burden and poor functional status should include the risk of permanent stoma. |
| [Mh] Termos MeSH primário: |
Neoplasias Peritoneais/patologia
Estomas Peritoneais/patologia
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| [Mh] Termos MeSH secundário: |
Biomarcadores Tumorais/análise
Terapia Combinada
Feminino
Seguimentos
Seres Humanos
Técnicas Imunoenzimáticas
Masculino
Meia-Idade
Estadiamento de Neoplasias
Neoplasias Peritoneais/cirurgia
Neoplasias Peritoneais/terapia
Estomas Peritoneais/cirurgia
Prognóstico
Estudos Prospectivos
Estudos Retrospectivos
Taxa de Sobrevida
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| [Pt] Tipo de publicação: | JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL |
[Nm] Nome de substância:
| 0 (Biomarkers, Tumor) |
| [Em] Mês de entrada: | 1610 |
| [Cu] Atualização por classe: | 170201 |
[Lr] Data última revisão:
| 170201 |
| [Sb] Subgrupo de revista: | IM |
| [Da] Data de entrada para processamento: | 150617 |
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1245/s10434-015-4674-1 |
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