Surgery · Oncology ·
Diversion Not Linked to Lower Leak Rates After CRS/HIPEC Pelvic Anastomosis
A systematic review and meta-analysis of 10 studies plus an institutional cohort included 1,506 patients undergoing cytoreductive surgery and HIPEC with pelvic anastomosis. Fecal diversion was not associated with a statistically significant reduction in anastomotic leaks, but was associated with more 60-day readmissions.
- No statistically significant reduction in leaks with diversion
- No difference in severe complications or length of stay
- Diversion associated with higher 60-day readmission odds
- Authors favor selective rather than routine diversion
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is used for peritoneal surface malignancies and can involve pelvic anastomoses. Whether a diverting ostomy reduces complications in this setting remains uncertain. Investigators searched PubMed and Embase for studies reporting diversion status and perioperative outcomes, and combined 10 eligible studies with an institutional cohort, for a total of 1,506 patients. The primary comparison was anastomotic leak rates in diverted and non-diverted patients.
Diversion was not associated with a statistically significant reduction in leaks (odds ratio [OR] 0.67, 95% CI 0.32–1.39; p=0.28). The analysis also found no differences in grade 3 or higher complications or length of stay. However, diversion was associated with higher odds of readmission within 60 days (OR 3.29, 95% CI 1.52–7.11; p<0.01).
The authors suggest considering selective rather than routine diversion in appropriately selected patients. The findings are based on a meta-analysis of studies with reported diversion status; the abstract does not provide further detail on study designs or adjustment for differences between patients who did and did not receive an ostomy. The results therefore do not establish that diversion causes increased readmissions or identify which patients can safely avoid it.
In practice
For patients undergoing CRS/HIPEC with a pelvic anastomosis, this pooled analysis found no statistically significant association between diverting ostomy and fewer anastomotic leaks, and no difference in severe complications or length of stay. Diversion was associated with higher odds of 60-day readmission, but the available report does not establish causation or provide enough detail to determine how patient selection affected comparisons. The findings support considering diversion selectively rather than routinely, but do not identify which patients can safely avoid it.
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Annals of Surgical Oncology: Evaluating the Association of Fecal Diversion with Morbidity in Patients Undergoing CRS/HIPEC with Pelvic Anastomoses: A Systematic Review and Meta-analysis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.