The Atypical Presentation and Delayed Timing of Anastomotic Leak in Patients Who Undergo Cytoreducation and Hyperthermic Intraperitoneal Chemotherapy.

INTRODUCTION

Anastomotic leak (AL) can be a disproportionately devastating complication following cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) due to its effect on both perioperative and oncologic outcomes. Anecdotally, patients who underwent CRS/HIPEC present in an atypically fashion compared to those who undergo non-CRS/HIPEC gastrointestinal surgery, but this has never been rigorously studied.

METHODS

The records for all consecutive patients who underwent CRS/HIPEC with curative intent from prospectively maintained databases at two high-volume centers were retrospectively reviewed. Those who experienced AL were identified and dichotomized into early (<POD10) and late (≥ POD 10) AL. Groups were analyzed using chi-squared, Fisher exact tests, and analysis of variance for categorical data and Mann-Whitney U or Kruskall-Wallis for continuous data.

RESULTS

On median postoperative day (POD) 15, 6.1% of patients experienced AL . Demographics, disease histology, risk factors for AL, receipt of neoadjuvant therapy, and extent of surgery were well-balanced. A higher proportion of small bowel anastomoses leaked in <POD10, whereas a higher proportion of ileocolonic and colorectal anastomoses leaked ≥ POD10. Patients in the late group were also significantly less likely to present with fever, tachycardia, and hypotension compared to patients in the early group, and patients in both cohorts were unlikely to present with peritonitis or leukocytosis.

CONCLUSIONS

Patients who experience AL after CRS/HIPEC often present in an atypical manner compared to those who undergo non-CRS/HIPEC gastrointestinal surgery. These findings are important to any practitioner who encounters CRS/HIPEC patients given that early recognition of AL is crucial to mitigating subsequent sequelae that can negatively impact both short-term perioperative and long-term oncologic outcomes in this uniquely challenging population.