Purpose: To compare the clinical presentation and timing of anastomotic leakage (AL) in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) versus conventional colorectal surgery (CCS), and to assess postoperative symptom trajectories to identify early indicators of AL. This study aims to improve timely recognition and facilitate earlier intervention of AL.
Patients and methods: We analyzed prospectively collected data from two Dutch teaching hospitals. We included adult patients who developed AL after elective CRS-HIPEC and CCS. We compared timing, severity, and clinical presentation of anastomotic leakage between patients after CRS-HIPEC and CCS. Furthermore, we analyzed and compared clinical symptoms, vital signs and laboratory values up to 5 days before AL diagnosis to evaluate symptom trajectories to identify early diagnostic indicators.
Results: Among 127 patients with anastomotic leakage, those who underwent CRS-HIPEC (n = 17) were diagnosed later (median 7 vs. 5 days, p < 0.001) and had longer hospital stays (median 24 vs. 16 days, p = 0.011). Except for a higher heart rate (mean 111 vs. 100 bpm, p = 0.02) and a steeper increase in the days preceding diagnosis in patients undergoing CRS-HIPEC, other symptoms and laboratory values were similar. Heart rate, temperature, and CRP began to increase in both groups the day before diagnosis.
Discussion: Anastomotic leakage was diagnosed later after CRS-HIPEC compared with CCS, with similar presentation, resulting in longer hospitalization. Symptoms began to increase the day before diagnosis. Future research should focus on developing a diagnostic algorithm based on dynamic postoperative trends to enable earlier intervention and improve outcomes.
© 2025. Society of Surgical Oncology.