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
Processing time: 170 Days and 21 Hours
ARTICLE HIGHLIGHTS
Research background

Tumor recurrence is common for patients with locally advanced rectal carcinoma after radical resection surgery. Over the past few years, intraoperative intraperitoneal chemotherapy has been gradually incorporated into the treatment for rectal carcinoma patients to decrease the recurrence rate and showed improved clinical outcomes. Nevertheless, the effects of intraoperative intraperitoneal chemotherapy on postoperative complications have rarely been explored. We conducted this research to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of anastomotic leakage (AL), which would be meaningful to promote our knowledge about the safety and feasibility of this emerging therapy modality.

Research motivation

Our study explored the safety of intraoperative intraperitoneal chemotherapy for patients receiving the anterior resection of rectal carcinoma. This is significant for surgeons to weigh the benefits and risks of this treatment technique.

Research objectives

Our research aimed to evaluate the role of intraoperative intraperitoneal chemotherapy in the occurrence of AL. Meanwhile, the prognosis of patients receiving this therapy was also analyzed.

Research methods

We performed a retrospective cohort study and patients were divided into a chemotherapy group and a control group. Important demographic variables and confounding factors were collected and analyzed through univariate analysis, stratification analysis, and multivariate analysis to control confounding bias. The oncological outcomes of the two groups were compared through the Kaplan-Meier method and log rank test.

Research results

We found that intraoperative intrapertitoneal chemotherapy increased the incidence of AL in patients receiving the anterior resection of rectal carcinoma, but this treatment also contributed to improved disease-free survival rate. This finding can help surgeons to weigh the benefits and risks of this emerging treatment method. Moreover, the mechanisms of intraoperative intraperitoneal chemotherapy leading to AL need to be further investigated in more basic studies. The effects of different types of chemotherapeautic agents on AL can also be explored.

Research conclusions

Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal cancer, but it also increases the risks of AL in patients receiving anterior resection of rectal carcinoma. Patients who have other risks of postoperative AL may not be suitable to receive this therapy.

Research prospective

Surgeons need to think deeply about the indications and contraindications of intraoperative intraperitoneal chemotherapy so that better clinical outcomes can be achieved in patients with rectal carcinoma. Moreover, our research is a retrospective study, and biases from data collection and analysis may exist. More prospective randomized controlled trials need to be conducted to explore the safety and feasibility of intraoperative intraperitoneal chemotherapy.