Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2019; 11(7): 538-550
Published online Jul 15, 2019. doi: 10.4251/wjgo.v11.i7.538
Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors
Zhi-Jie Wang, Jin-Hua Tao, Jia-Nan Chen, Shi-Wen Mei, Hai-Yu Shen, Fu-Qiang Zhao, Qian Liu
Zhi-Jie Wang, Jin-Hua Tao, Jia-Nan Chen, Shi-Wen Mei, Hai-Yu Shen, Fu-Qiang Zhao, Qian Liu, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
Author contributions: Wang ZJ and Tao JH designed the research; Chen JN, Mei SW, Shen HY, and Zhao FQ collected and analyzed the data; Wang ZJ drafted the article; Liu Q revised the paper.
Supported by Medicine and Health Technology Innovation Project of Chinese Academy of Medical Sciences, No. 2017-12M-1-006.
Institutional review board statement: Our investigation received approval from the ethics committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College.
Informed consent statement: All patients have signed an informed consent form before the study.
Conflict-of-interest statement: The authors declare that there is no conflict of interest in regard to this research.
STROBE statement: The authors have carefully read the STROBE Statement checklist of items and prepared the manuscript based on the requirements of STROBE Statement checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qian Liu, MD, Professor, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. fcwpumch@163.com
Telephone: +86-10-87787110 Fax: +86-10-87787110
Received: January 27, 2019
Peer-review started: January 28, 2019
First decision: April 15, 2019
Revised: May 1, 2019
Accepted: May 28, 2019
Article in press: May 29, 2019
Published online: July 15, 2019
Abstract
BACKGROUND

Intraoperative intraperitoneal chemotherapy is an emerging treatment modality for locally advanced rectal neoplasms. However, its impacts on postoperative complications remain unknown. Anastomotic leakage (AL) is one of the most common and serious complications associated with the anterior resection of rectal tumors. Therefore, we designed this study to determine the effects of intraoperative intraperitoneal chemotherapy on AL.

AIM

To investigate whether intraoperative intraperitoneal chemotherapy increases the incidence of AL after the anterior resection of rectal neoplasms.

METHODS

This retrospective cohort study collected information from 477 consecutive patients who underwent an anterior resection of rectal carcinoma using the double stapling technique at our institution from September 2016 to September 2017. Based on the administration of intraoperative intraperitoneal chemotherapy or not, the patients were divided into a chemotherapy group (171 cases with intraperitoneal implantation of chemotherapy agents during the operation) or a control group (306 cases without intraoperative intraperitoneal chemotherapy). Clinicopathologic features, intraoperative treatment, and postoperative complications were recorded and analyzed to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of AL. The clinical outcomes of the two groups were also compared through survival analysis.

RESULTS

The univariate analysis showed a significantly higher incidence of AL in the patients who received intraoperative intraperitoneal chemotherapy, with 13 (7.6%) cases in the chemotherapy group and 5 (1.6%) cases in the control group (P = 0.001). As for the severity of AL, the AL patients who underwent intraoperative intraperitoneal chemotherapy tended to be more severe cases, and 12 (92.3%) out of 13 AL patients in the chemotherapy group and 2 (40.0%) out of 5 AL patients in the control group required a secondary operation (P = 0.044). A multivariate analysis was subsequently performed to adjust for the confounding factors and also showed that intraoperative intraperitoneal chemotherapy increased the incidence of AL (odds ratio = 5.386; 95%CI: 1.808-16.042; P = 0.002). However, the survival analysis demonstrated that intraoperative intraperitoneal chemotherapy could also improve the disease-free survival rates for patients with locally advanced rectal cancer.

CONCLUSION

Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal carcinoma, but it also increases the risk of AL following the anterior resection of rectal neoplasms.

Keywords: Anastomotic leakage, Rectal neoplasms, Lobaplatin, Fluorouracil implants, Postoperative complications, Intraoperative intraperitoneal chemotherapy

Core tip: Intraoperative intraperitoneal chemotherapy is gradually administered during operations for locally advanced rectal cancer patients. It is believed that this treatment can improve the oncological outcomes and survival rates. However, surgical complications related to intraoperative chemotherapy have also been reported. We conducted this study to determine the relationship between intraperitoneal chemotherapy and anastomotic leakage to help surgeons weigh the benefits and risks of intraoperative chemotherapy.