Anastomosis versus rectal stump procedure in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for colorectal and appendiceal peritoneal metastases: A comparative study.

AIM: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard treatment for peritoneal metastases (PM) of colorectal or appendiceal origin. Rectal anastomotic leakage (RAL) or rectal stump blow-out is a serious complication following rectal resection after CRS-HIPEC. This study aimed to compare outcomes between ileo-/colorectal anastomosis and rectal stump procedure and to identify risk factors for RAL and blow-out.

METHOD: Data were retrospectively collected between 2012 and 2024 from a prospectively maintained HIPEC Registry and supplemented with the review of medical records. Postoperative complications and the prevalence of RAL or blow-out were registered. Pearson's chi-squared test was used to compare differences in categorical variables. Logistic regression was used to identify risk factors for RAL and blow-out.

RESULTS

Among 1271 CRS-HIPEC procedures, 332 involved rectal resections. Patients received either an ileo-/colorectal anastomosis (n = 158) or had a rectal stump procedure (n = 174). RAL occurred in 5.7% and blow-out in 2.9% (p = 0.201). In the rectal stump group, patients were older (65 vs. 59 years; p = <0.001), had higher PCI scores (p = 0.031) and more often had received neoadjuvant treatment (p = 0.025). Logistic regression showed no independent association between RAL and type of rectal reconstruction (OR 1.99; 95% CI: 0.61-6.51), low anastomotic level (OR 2.17; 95% CI: 0.50-9.42) or peritoneal cancer index >21 (OR 6.47; 95% CI: 0.84-50.1).

CONCLUSION

Both reconstruction strategies following rectal resection in CRS-HIPEC were associated with low rates of RAL or blow-out. No independent risk factors were identified, indicating that the choice of surgical approach should be individualized based on clinical context rather than presumed leakage risk.