QS16. Outcomes in patients with pelvic anastomosis during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with and without diverting ostomy

Thursday, March 5, 2026

10:19 AM - 10:23 AM MST

Location: Pan-Tumor HUB Zone

Primary Presenter(s)

Jennifer A. Wylie, MD (she/her/hers)

General Surgery Resident
Atrium Health Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States

Slides

Co-Author(s)

Audry S. Sebikali-Potts, MD

General Surgery Resident
Department of Surgery, Wake Forest Baptist Medical Center
Winston Salem, North Carolina, United States
GR

Gregory B. Russel, MS

Senior Statistician
Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States
NE

Nancy C. Edwards, MD

General Surgery Resident
Department of Surgery, Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States
TA

Thomas J. Atchison, MD

General Surgery Resident
Department of Surgery, Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States
WB

William N. Butler, MD

General Surgery Resident
Department of Surgery, Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States
BN

Brooke E. Nunn, MD

General Surgery Resident
Department of Surgery, Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States
SR

Sofia M. Russo, MD

General Surgery Resident
Department of Surgery, Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States
MC

Madeleine M. Carroll, MD

General Surgery Resident
Department of Surgery, Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States
Konstantinos I. Votanopoulos, MD, PhD

Professor
Department of Surgery, Wake Forest Organoid Research Center, Wake Forest University School of Medicine
Winston-Salem, North Carolina, United States
Edward A. Levine, MD

Chief, Surgical Oncology
Wake Forest University
Winston-Salem, North Carolina, United States
FJ

Fabian M. Johnston, MD, MHS

Chair, Professor of Surgery
Department of Surgery, Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States
PS

Perry Shen, MD (he/him/his)

Professor
Department of Surgery, Wake Forest University School of Medicine
Winston Salem, North Carolina, United States

Introduction: The need for diverting ostomy in patients undergoing pelvic anastomosis during CRS+HIPEC remains debated. This study compares patient characteristics and postoperative outcomes between those with and without protective ostomies to clarify the role of diversion in this population.

Methods: We conducted a retrospective chart review of patients who underwent CRS+HIPEC with pelvic anastomosis at a single academic institution. Preoperative and intraoperative variables were analyzed using descriptive statistics to compare outcomes between patients with and without ostomies.

Results: From January 2012 to June 2025, 95 of 490 patients who underwent CRS+HIPEC had a pelvic anastomosis (19.4%). Of these, 74 (78%) received a protective loop ileostomy or colostomy. There were no significant differences observed in patient demographics, comorbidities, or disease status between those who received ostomies and those who did not. Resection status, number of anastomoses, timing of pelvic anastomosis relative to chemotherapy perfusion, and leak test results were also similar. However, patients with ostomies experienced higher mean blood loss (1117.9 vs 753.6 mL, p=0.025) and longer operative times (629.3 vs 553.3 minutes, p=0.078). Patients without ostomies had higher rates of hand-sewn pelvic anastomosis (29% vs 8%, p=0.023), reoperation prior to discharge (24% vs 3%, p=0.0053), and pelvic anastomotic leak (20% vs 2%, p=0.011). Both patients with and without ostomies experienced comparable rates of Clavien-Dindo grade III/IV complications (21% vs 29%, p=0.55) and similar median overall survival (27.7 vs 35.5 months, p=0.68). Although the difference in 30-day mortality did not reach statistical significance, a higher rate was observed in patients without diversion (10% vs 4%, p=0.30).

Conclusions: The use of a protective ostomy in patients undergoing pelvic anastomosis during CRS+HIPEC was associated with decreased rates of pelvic anastomotic leak and reoperation. Improved 30-day mortality was also observed with diversion. These findings support the continued use of diverting ostomy to reduce postoperative morbidity and mortality in this high-risk population.

Learning Objectives:

Participants should be able to identify similarities and differences between patient pre-operative characteristics in those undergoing pelvic anastomosis during CRS+HIPEC with and without diversion.
Participants should be able to identify similarities and differences between intra-operative variables in those undergoing pelvic anastomosis during CRS+HIPEC with and without diversion.
Participants should be able to identify similarities and differences between post-operative outcomes, including complication rates and mortality, in those undergoing pelvic anastomosis during CRS+HIPEC with and without diversion.