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Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, Jurado M, Tejerizo A, Padilla-Iserte P, Malune ME, Di Donna MC, Marina T, Sanchez-Iglesias JL, Chiva L, Olloqui A, Matute L, García-Granero A, Cárdenas-Rebollo JM, Domingo S. Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction. Gynecol Oncol 2020; 158:603-607. [PMID: 32571682 DOI: 10.1016/j.ygyno.2020.05.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. METHODS We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. RESULTS The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p<0.001]; extended operating time [OR 1.005 (1.003-1.006); p<0.001] and intra-operative red blood transfusion [OR 2.7 (1.4-5.3); p<0.001] were found to be independently associated with diverting ileostomy performance. Assuming a 7% AL rate cut-off, up to 51.8% of DI presented an AL risk below 7% and might have been spared. CONCLUSIONS The risk factors that drive the gynecologic oncology surgeons to perform a diverting ileostomy, seem to differ from the actual risk factors that we have identified to be associated with postoperative anastomotic leak. Broader awareness of the risk factors that contribute to a higher perioperative risk profile, will facilitate a better risk stratification process and possibly avoid unnecessary stoma formation in ovarian cancer patients.
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Affiliation(s)
- V Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain.
| | - C Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - L Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - A Gil-Moreno
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - P A Cascales-Campos
- Department of General Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Tejerizo
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - P Padilla-Iserte
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - M E Malune
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - M C Di Donna
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - T Marina
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - J L Sanchez-Iglesias
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Chiva
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Olloqui
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - L Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - A García-Granero
- Department of General Surgery, University Hospital Son Espases, Palma de Mallorca, Spain; Department of Human Embryology and Anatomy, University of Valencia, Valencia, Spain
| | - J M Cárdenas-Rebollo
- Department of Applied Mathematics and Statistics, CEU San Pablo University, Madrid, Valencia, Spain
| | - S Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
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Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, Jurado M, Tejerizo A, Padilla-Iserte P, Malune ME, Di Donna MC, Marina T, Sánchez-Iglesias JL, Olloqui A, García-Granero Á, Matute L, Fornes V, Domingo S. Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study. Gynecol Oncol 2019; 153:549-554. [PMID: 30952369 DOI: 10.1016/j.ygyno.2019.03.241] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. BACKGROUND In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. METHODS Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. RESULTS The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). CONCLUSIONS Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided.
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Affiliation(s)
- V Lago
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain.
| | - C Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - L Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - A Gil-Moreno
- Department of Obstetrics and Gynecology, Vall d'Hebron, Barcelona, Spain
| | - P A Cascales-Campos
- Department of General Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Navarre, Spain
| | - A Tejerizo
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - P Padilla-Iserte
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - M E Malune
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - M C Di Donna
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - T Marina
- Department of Gynecology, Valencian Institute of Oncology, Valencia, Spain
| | | | - A Olloqui
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - Á García-Granero
- Department of General Surgery, University Hospital La Fe, Valencia, Spain
| | - L Matute
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - V Fornes
- Unit of Biostatistics, Health Research Institute Hospital La Fe, Valencia, Spain
| | - S Domingo
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
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Lago V, Bello P, Montero B, Matute L, Padilla-Iserte P, Lopez S, Agudelo M, Domingo S. Clinical application of the sentinel lymph node technique in early ovarian cancer: a pilot study. Int J Gynecol Cancer 2018; 29:377-381. [DOI: 10.1136/ijgc-2018-000049] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/20/2018] [Accepted: 10/04/2018] [Indexed: 11/03/2022] Open
Abstract
IntroductionThere is limited evidence favoring the use of the sentinel lymph node technique in ovarian cancer, and no standardized approach has been studied. The objective of the present pilot study is to determine the feasibility of the sentinel lymph node technique by applying a clinical algorithm.MethodsPatients with confirmed ovarian cancer were included. 99mTc and indocyanine green were injected into the ovarian and infundubulo-pelvic ligament stump. A gamma probe and near-infrared fluorescence imaging were used for sentinel lymph node detection.ResultsThe sentinel lymph node technique was performed in ten patients with a detection rate in the pelvic and/or para-aortic region of 100%. The tracer distribution rates of sentinel lymph nodes in the pelvic and para-aortic regions were 87.5% and 70%, respectively.ConclusionThe detection of sentinel lymph nodes in early-stage ovarian cancer appears to be achievable. Based on these results, a clinical trial entitled SENTOV (SENtinel lymph node Technique in OVarian cancer) will be performed.
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