Surgical complications related to hematopoietic stem cell transplantation

Diverting Enterostomy Improves Overall Survival of Patients with Severe Steroid-Refractory Gastrointestinal Acute Graft-versus-host Disease

OBJECTIVE

To evaluate the benefit of diverting enterostomy (DE) in patients with severe steroid-refractory (SR) gastrointestinal acute graft-versus-host-disease (GI-aGVHD) following allogeneic hematopoietic stem-cell transplantation (ASCT).

SUMMARY AND BACKGROUND DATA

Severe GI-aGVHD refractory to the first line steroid therapy is a rare but dramatic life-threatening complication. Second lines of immunosuppressors have limited effects and increase the risk of sepsis. Data suggest that limiting GI bacterial translocation by DE could restrain severe GI-aGVHD.

METHODS

From 2004 to 2018, we retrospectively reviewed all consecutive patients undergoing ASCT for hematologic malignancies who developed severe SR GI-aGVHD. We compared patients in whom a proximal DE was performed (Enterostomy group) with those not subjected to DE (Medical group). The primary endpoint was the 1-year overall survival (OS) measured from the onset of GI-aGVHD. Secondary endpoints were the 2-year OS and causes of death.

RESULTS

Of the 1295 patients who underwent ASCT, 51 patients with severe SR GI-aGVHD were analyzed (13 in Enterostomy group and 38 in Medical group). Characteristics of patients, transplantation modalities, and aGVHD severity were similar in both groups. The 1-year OS was better after DE (54% vs. 5%, P = 0.0004). The 2-year OS was also better in "Enterostomy group" (31% vs. 2.5%; P = 0.0015), with a trend to lower death by sepsis (30.8% vs. 57.9%; P = 0.091).

CONCLUSION

DE should be considered for severe GI-aGVHD as soon as resistance to the corticosteroid is identified.

Prevalence and recurrence rate of perianal abscess--a population-based study, Sweden 1997-2009

INTRODUCTION

The aim of this study was to assess the impact of diabetes mellitus, Crohn's disease, HIV/aids, and obesity on the prevalence and readmission rate of perianal abscess.

METHODS

The study cohort was based on the Swedish National Patient Register and included all patients treated for perianal abscess in Sweden 1997-2009. The prevalence and risk for readmission were assessed in association with four comorbidity diagnoses: diabetes mellitus, Crohn's disease, HIV, and/or AIDS and obesity.

RESULTS

A total of 18,877 patients were admitted during the study period including 11,138 men and 4557 women (2.4:1). Crohn's disease, diabetes, and obesity were associated with a significantly higher prevalence of perianal abscess than an age- and gender-matched background population (p < 0.05). In univariate analysis, neither age nor gender had any significant impact on the risk for readmission. In a multivariate Cox proportional hazard analysis, Crohns disease was the only significant risk factor for readmission of perianal abscess.

CONCLUSION

Crohn's disease, diabetes, and obesity increase the risk for perianal abscess. Of these, Crohn's and HIV has an impact on readmission. The pathogenesis and the influence of diabetes and obesity need further research if we are to understand why these diseases increase the risk for perianal abscess but not its recurrence.

Predictors of the development of surgical complications among hematopoietic stem cell transplantation recipients

BACKGROUND

This study was designed to determine possible risk factors for the development of surgical complications after hematopoietic stem cell transplantation (HSCT). HSCT carries the possibility for the development of surgical morbidities and mortalities; certain populations of patients are at higher risk for developing complications. Defining those risk factors will help surgeons to anticipate and manage these complications.

METHODS

The records of 165 patients at King Hussein Cancer Center (KHCC) were reviewed from January 2007 to December 2008. Patients' characteristics, including age, source and type of transplant, behavior of disease, total body irradiation (TBI), immunity status, and intensity of conditioning were studied.

RESULTS

According to our data, abdominal complications were more common among patients who received TBI versus patients who did not, and in patients who received peripheral blood versus bone marrow and cord blood as the source of stem cells. Ear, nose, and throat (ENT) complications were found more in patients who underwent nonmyeloablation conditioning. Catheter-related complications were found more significantly in immune-compromised patients during the post-engraftment period. We also found that ENT complications were more frequent in patients with cord blood as the source of stem cells, although the results are inconclusive due to the small sample size.

CONCLUSIONS

Pretransplantation factors can be used as predictors for the development of surgical complications in HSCT recipients. Abdominal complications were significantly more common in patients who received total body irradiation as part of their conditioning regimen and when the peripheral blood was a source for stem cell transplantation.