细胞还原及腹腔内高温化疗患者吻合口瘘的不典型表现及延迟时间

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-10-09 DOI:10.1016/j.jss.2025.09.037

Colin J. Rog MD , Riom Kwakman MD , Charlotte van Schooten MD , Chloe Hanson MD , Elizabeth J. Olecki MD , Richard A. Erali MD , Joy Sarkar MD , Erek Nelson MD , Matthew G.K. Benesch MD, PhD , Shalana O'Brien MD , Gary Mann MD , Joseph Skitzki MD , Mohamed Alassas MD , Evan S. Ong MD

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引用次数: 0

摘要

由于吻合口漏（AL）对围手术期和肿瘤预后的影响，它可能是细胞减少手术(CRS)/腹腔高温化疗（HIPEC）后不成比例的破坏性并发症。有趣的是，与那些接受非CRS/HIPEC胃肠道手术的患者相比，接受CRS/HIPEC的患者表现出非典型的方式，但这从未得到严格的研究。方法回顾性分析两个大容量中心前瞻性维护的数据库中所有连续接受CRS/HIPEC治疗的患者的记录。识别出经历AL的患者并将其分为早期（<POD10）和晚期（≥POD10） AL。分类数据采用卡方检验、Fisher精确检验和方差分析，连续数据采用Mann-Whitney U或Kruskall-Wallis分析。结果术后中位天（POD） 15，有6.1%的患者发生AL。人口统计学、疾病组织学、AL的危险因素、新辅助治疗的接受情况和手术范围都很平衡。≥POD10时，小肠吻合口漏的比例较高，而≥POD10时，回肠和结肠吻合口漏的比例较高。与早期组患者相比，晚期组患者出现发热、心动过速和低血压的可能性也显著降低，两组患者均不太可能出现腹膜炎或白细胞增多。结论与非CRS/HIPEC胃肠道手术患者相比，CRS/HIPEC术后发生AL的患者通常表现为非典型。这些发现对任何遇到CRS/HIPEC患者的医生都很重要，因为在这一独特的具有挑战性的人群中，早期识别AL对于减轻可能对短期围手术期和长期肿瘤预后产生负面影响的后续后遗症至关重要。

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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.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.