Stoma creation at the time of large bowel resection during ovarian cytoreductive surgery does not improve 30-day postoperative surgical outcomes

Abstract

Objectives: Large bowel resections (LBR) are occasionally required to achieve optimal resection during cytoreductive surgery for ovarian cancer. Stoma creation (SC) has been proposed as a protective measure to reduce the incidence and potential consequences of an anastomotic leak after LBR; however there is conflicting data on whether this does indeed reduce rates of leak. The objectives of this study were to evaluate the rate of SC at time of LBR during ovarian cytoreductive surgery (OCS), and to determine whether SC reduces the rates of sepsis and reoperation. Methods: Women who underwent LBR at time of OCS from 2013 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using corresponding CPT, ICD-9, and ICD-10 codes. SC was determined based on CPT codes. Comparative analyses were then stratified by SC to evaluate demographics, preoperative and intraoperative variables, and surgical outcomes. Statistical tests were performed with R Studio v.1.1.456. Results: A total of 8,750 women who underwent OCS were identified, and 1,603 (18.3%) of these women underwent a concurrent LBR. Among the women who had a LBR, 1,418 (88.5%) had one bowel resection and 185 (11.5%) had multiple bowel resections performed. At the time of LBR, 1,003 (62.6%) had a primary anastomosis without SC, 272 (17.0%) had a colostomy, and 190 (11.8%) had an ileostomy. SC data was not available for 138 (8.6%) women, and these women were excluded from analysis. Preoperatively, women with SC tended to be of older age, and have a higher body mass index (BMI), higher American Society of Anesthesiology (ASA) class, higher White blood cell count, and lower albumin level. Women who had multiple bowel resections were more likely to have SC at time of OCS (17.3% vs. 8.4%, p Download : Download high-res image (120KB) Download : Download full-size image Conclusions: Over a quarter of women who had a concurrent LBR at time of OCS underwent SC. These women tended to be older with higher BMI and ASA class. Although the specific indications for SC are not captured in the NSQIP database, SC was associated with higher rates surgical site infection, organ space infection, sepsis, and hospital readmission during the 30-day postoperative period.