Available online 16 April 2024, 102080

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CRS with HIPEC for colorectal cancer comes with a low risk for anastomotic leakage.

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No correlation between number of anastomosis and anastomotic leakage.

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No specific risk factor for anastomotic leakage could be found in this cohort.

AbstractBackground

Extended oncological resections for colorectal cancer surgery are associated with a high rate of complications, especially anastomotic leakage (AL). This study determines the incidence of risk factors for postoperative complications following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal cancer (CRC).

Methods

In this cohort study, the clinical data of all patients with CRC, treated with CRS and HIPEC, from 2011 to 2021 was analyzed. We considered patients’ characteristics, tumor-specific features, postoperative complications, and hospital stay using chi-Square-test or Fisher’s exact test. The Mann-Whitney-U-test was used to measure the probability of differences between two sets of data.

Results

Of 1089 HIPEC procedures performed in the study center, 185 patients with CRC and peritoneal metastasis were treated with CRS and HIPEC after formation of at least one anastomosis and therefore included in this study. This included synchronous and metachronous peritoneal metastasis with a mean peritoneal cancer index of 8.67 ± 5.22. In this cohort, AL occurred in 12 (6.5%) patients. There was no correlation between the number of anastomoses and the occurrence of an AL (p = 0.401).

Conclusion

This study reports a low risk of AL after CRS with HIPEC for CRC, comparable to other published data. If a complete cytoreduction seems possible, the risk of anastomotic leakage should not negatively influence the decision to resect. Further studies on this subject are essential to validate our findings.

Section snippets1. Introduction.

Colorectal cancer (CRC) is one of the most frequent cancers in the world [1]. After the liver, the second most common site of CRC metastasis is the peritoneum [2]. Therefore, CRC is invariably witnessed with a relative high risk of synchronous or metachronous peritoneal metastasis (PM) of up to 15 % and 20 %, respectively [3]. Even during the era of specialized chemotherapy and targeted treatment options, the prognosis of peritoneal metastasis remains poor with a median survival of only a few

Study cohort and design

All patients treated with CRS and HIPEC for CRC in the Hospital Barmherzige Brüder, Regensburg, Germany between January 2011 and December 2021 were included. The study center is a national referral center for peritoneal malignancy. Patients without any colorectal anastomosis were excluded from this study (Figure 1). The primary endpoint was the occurrence of an AL after at least one intestinal anastomosis and HIPEC to determine risk factors for postoperative AL.

We extracted patients’

Results

From January 2011 to December 2021, a total of 1089 patients were treated by CRS and HIPEC in the center. In 26.4% cases, colorectal malignancy was metastasized to the PM. Referring to AL after CRS and HIPEC, 185 patients with CRS and HIPEC for CRC with at least one anastomosis were included in this study. This included 87 men and 98 women with a mean age of 55.11 ± 11.75 years. 10 patients had a non-restorative procedure with at least one additional anastomosis. Within the study cohort, AL

Discussion

This study showed an AL rate of 6.5% after CRS and HIPEC for CRC. The only identifiable risk factor for AL was the performance of an ileorectal anastomosis (p<0.033). Other previously described factors such as sex, number of anastomoses or PCI showed no significant effect on the occurrence of a postoperative leakage after CRS and HIPEC.

First, this study underlines a significant safety profile even in the presence of several anastomoses in CRS and HIPEC for CRC. A leakage rate of 6.5% is in line

Conclusion

Our study from a high-volume German center reports a comparably low rate of AL after CRS and HIPEC for CRC with PM. As the anastomoses were performed before the HIPEC procedure, the clinical impact of this technique seems to be lower than estimated in previous studies. We could not find a significant and independent risk factor for AL that should be considered during the risk evaluation of patients undergoing CRS with HIPEC. Validations of our findings by oncological colorectal surgical

Declaration of Competing Interest

The authors declare no conflict of interest and no external financial support for this study.

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