Does Intraperitoneal Chemotherapy Increase the Incidence of Anastomotic Leakage after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis.

Yu Yang,Xiaohui Du,Yuxuan Li,Oronzo Brunetti

doi:10.1155/2021/9204373

Abstract

Purpose To identify and evaluate the influence of intraperitoneal chemotherapy without hyperthermia (ICwh) to the incidence of anastomotic leakage (AL) after colorectal cancer surgery. Methods A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses in order to review all studies investigating the relationship between ICwh and AL in patients undergoing colorectal surgery. The primary outcome was overall incidence rate of anastomotic leakage. Results Four studies were included in the final review. ICwh was associated with an overall increased risk of anastomotic leakage [OR 2.05 (1.06, 3.98), P = 0.03]. But there was no significant increased incidence rate when fluorouracil was implanted into the abdominal cavity for ICwh [OR 2.48 (0.55, 11.10), P = 0.24]. Conclusions This meta-analysis provides some evidence to suggest ICwh may increase the incidence of postoperative AL in colorectal cancer. However, fluorouracil implantation for ICwh does not increase the risk of AL, which seems to be a relatively safe method of ICwh.

Highlights

Colorectal cancer ranks third in terms of incidence and second in terms of mortality among all cancers [1]
According to the same period and same institution about intraperitoneal chemotherapy without hyperthermia (ICwh) with lobaplatin, data presented that only 2% (1/50) had anastomotic leakage; we regard this set of data as the use of fluorouracil only and combine with the data in Yuan et al.’s [3] study to analyze the relationship between the use of fluorouracil implanted into the abdominal cavity as ICwh and the occurrence of AL after colorectal cancer surgery
The evidence in this study indicates that ICwh increases the incidence of anastomotic leakage

Summary

Introduction

Colorectal cancer ranks third in terms of incidence and second in terms of mortality among all cancers [1]. Chemotherapy plays an important role in preventing cancer recurrence and metastasis. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been widely used, but based on advantages of straightforward operation and good tolerance, intraperitoneal chemotherapy without hyperthermia (ICwh) has become one of the important means of comprehensive treatment of colorectal cancers under the concept of enhanced recovery after surgery (ERAS). Regarding the relationship between ICwh and postoperative complications, especially the occurrence of anastomotic leakage (AL), the results of different studies are not consistent [3, 4]. The main purpose of this meta-analysis is to provide better evidence for whether ICwh increases the incidence of anastomotic leakage after colorectal cancer surgery

Methods

Results

Conclusion