Risk of definitive stoma after surgery for peritoneal malignancy in 958 patients: comparative study between complete cytoreductive surgery and maximal tumor debulking

Our plain-English summary of Risk of definitive stoma after surgery for peritoneal malignancy in 958 patients: comparative study between complete cytoreductive surgery and maximal tumor debulking, by S. Riss, K. Chandrakumaran, S. Dayal, et al (European Journal of Surgical Oncology, 2015).

The study

• Authors: S. Riss, K. Chandrakumaran, S. Dayal, T.D. Cecil, F. Mohamed, B.J. Moran
• Journal: European Journal of Surgical Oncology
• Published: 2015;41(3):392-5
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Complete cytoreductive surgery (CRS) can achieve cure or long-term survival in selected patients with peritoneal malignancy. In selected patients, due to extensive disease, complete tumour removal is impossible and optimal strategy may be maximal tumour debulking (MTD). We analysed the stoma related outcome in a series of patients undergoing surgery in a National Peritoneal Malignancy Referral Centre.

Methods: All patients who underwent CRS, with or without, intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) between 1994 and 2012 were included. Data was collected prospectively in an institutional database and analysed retrospectively.

Results: CRS was performed in 958 patients (female: 595, male: 363) of whom 781 (81.5%) had a primary appendix tumour, 63 (6.6%) had a colorectal primary, 47 (4.9%) peritoneal mesothelioma, 38 (4%) an ovarian tumour and 29 patients (3%) other tumours. Complete CRS was achieved in 72% (693/958). Overall 352/958 (37%) had a stoma, which was permanent in 165/958 (17.2%). The median time interval from CRS to reversal of stoma was 4.4 months (range: 1.4-13.8). Stomas were created in 113/265 (42.6%) at MTD (permanent: n = 105 (93%), temporary: n = 8 (7%)), and 239/693 (34.5%) at complete CRS (permanent: n = 60 (25%), temporary: n = 179 (75%)) (p = 0.020). All temporary stomas in the 168/693 (24.4%) of patients who had complete CRS were subsequently reversed.

Conclusion: To achieve complete CRS for peritoneal malignancy a stoma is often required and in a proportion this will be permanent. Overall over one third had a stoma at surgery with almost half subsequently reversed.

Copyright © 2014 Elsevier Ltd. All rights reserved.

In plain English

This study, from a national peritoneal malignancy referral centre in Basingstoke, UK, reviewed prospectively collected records of 958 patients who had cytoreductive surgery (removal of tumour from the abdominal lining), with or without heated chemotherapy inside the abdomen. Most had appendix tumours. 47 (4.9%) had peritoneal mesothelioma, but the article neither reported their results separately nor discussed asbestos. Complete tumour removal was achieved in 693 patients. The other 265 had maximal tumour debulking because complete removal was not possible. A stoma (bowel brought out through the abdominal wall) was created in 239 of 693 complete-surgery patients and 113 of 265 debulking patients. Overall, 352 of 958 had a stoma, which was permanent in 165 of 958. All 168 planned temporary stomas in the complete-surgery group were reversed. In the debulking group only 8 of 13 were reversed, the rest mainly because of tumour progression. Thirteen patients (7%) had complications after reversal, with no deaths. The authors concluded that a stoma is often required to achieve complete surgery and is sometimes permanent. Several figures in the article disagree with each other.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of a prospectively maintained institutional database at a single referral centre (surgical outcome series)
• Who was studied: Consecutive patients with peritoneal malignancy treated at a National Peritoneal Malignancy Referral Centre (Basingstoke and North Hampshire Hospital, UK). There were 958 analysed (the methods say 959): 595 female and 363 male, median age 56 (range 18 to 84). By main tumour: 781 (81.5%) primary appendix tumour, 63 (6.6%) colorectal primary, 47 (4.9%) peritoneal mesothelioma, 38 (4%) ovarian tumour, 29 (3%) other. Period given as 1994 to 2010 in the methods and 1994 to 2012 in the abstract.
• Exposure: No asbestos exposure or fiber type is studied or mentioned. The comparison is between two kinds of surgery: complete cytoreductive surgery (CRS) versus maximal tumour debulking (MTD), with or without hyperthermic intraperitoneal chemotherapy (HIPEC).
• Main results:
  • Complete CRS was achieved in 72% of patients (693/958). The remaining 28% (265) had maximal tumour debulking.
  • In the complete CRS group, 239/693 (35%) received a stoma.
  • In the complete CRS group, 168/693 (24.4%) had a planned temporary stoma, and all of these were later reversed.
  • In the maximal tumour debulking group, 113 patients (43%) required a stoma at the index operation.
  • In the maximal tumour debulking group, 13 had a planned temporary stoma but only 8/13 (62%) were reversed. The authors attributed the other 5 permanent stomas predominantly to tumour progression.
  • Across all patients, 352/958 (37%) had a stoma, and the stoma was permanent in 165/958 (17.2%).
  • Among patients whose stoma was reversed, the median time from CRS to reversal was 4.4 months (range 1.4 to 13.8 in the results section).
  • Overall, 181/352 (51%) of patients with a stoma had a planned temporary stoma, which was reversed in 97% of them.
  • Thirteen patients (7%) developed postoperative complications after stoma reversal, most commonly small bowel obstruction (7 patients). No deaths were associated with stoma reversal.
• The authors' conclusion: The authors concluded that achieving complete CRS for peritoneal malignancy often requires a stoma, and in a proportion of patients it will be permanent. They also stated that a temporary stoma made during complete CRS can generally be reversed with a relatively low complication rate. In contrast, a permanent stoma is more often required after maximal debulking.
• Limitations the authors state:
  • The authors note that the study is a retrospective analysis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Colon cancer, Mesothelioma, Ovarian cancer, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma.

Related studies

• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• A new policy regarding ovarian resection in young women treated for peritoneal carcinomatosis — D. Elias, E. Duchalais, et al. (2013)
• Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases — M. Dhir, L. Ramalingam, et al. (2017)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)

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