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Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction


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Title: Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction
Authors : Lago Leal, Víctor
Fotopoulou, C.
Chiantera, V.
Minig Ramos, Lucas
Gil Moreno, A.
Cascales Campos, P. A.
Jurado, Miguel
Tejerizo, A.
Padilla Iserte, Pablo
Malune, M. E.
Di Donna, M. C.
Marina, T.
Sanchez-Iglesias, J. L.
Chiva, L.
Olloqui, A.
Matute, L.
García-Granero, A.
Cárdenas Rebollo, José Miguel
Domingo del Pozo, Santiago
Keywords: Anastomotic leakDiverting ileostomyOvarian cancerRisk factors
Publisher: Elsevier
Citation: Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, Jurado M, Tejerizo A, Padilla-Iserte P, Malune ME, Di Donna MC, Marina T, Sanchez-Iglesias JL, Chiva L, Olloqui A, Matute L, García-Granero A, Cárdenas-Rebollo JM, Domingo S. Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction. Gynecol Oncol. 2020 Sep;158(3):603-607. doi: 10.1016/j.ygyno.2020.05.047. Epub 2020 Jun 19. PMID: 32571682.
Abstract: Objective: To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. Methods: We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. Results: The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p<0.001]; extended operating time [OR 1.005 (1.003-1.006); p<0.001] and intra-operative red blood transfusion [OR 2.7 (1.4-5.3); p<0.001] were found to be independently associated with diverting ileostomy performance. Assuming a 7% AL rate cut-off, up to 51.8% of DI presented an AL risk below 7% and might have been spared. Conclusions: The risk factors that drive the gynecologic oncology surgeons to perform a diverting ileostomy, seem to differ from the actual risk factors that we have identified to be associated with postoperative anastomotic leak. Broader awareness of the risk factors that contribute to a higher perioperative risk profile, will facilitate a better risk stratification process and possibly avoid unnecessary stoma formation in ovarian cancer patients.
Description: Acceso al texto completo del artículo, disponible desde el sitio de la revista usando DOI: https://doi.org/ 10.1016/j.ygyno.2020.05.047
URI: http://hdl.handle.net/10637/15214
Rights : http://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
ISSN: 0090-8258
Issue Date: 19-Jun-2020
Center : Universidad San Pablo-CEU
Appears in Collections:Enfermería





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