Evaluating the Association of Fecal Diversion with Morbidity in Patients Undergoing CRS/HIPEC with Pelvic Anastomoses: A Systematic Review and Meta-analysis
In brief
Diverting ostomies did not significantly reduce leaks after CRS/HIPEC
In a meta-analysis of 1,506 patients undergoing CRS/HIPEC with a pelvic anastomosis, diversion was not linked to a significant drop in anastomotic leaks or severe complications, but was associated with more readmissions within 60 days. The findings support considering diversion selectively rather than routinely, though the evidence does not establish which patients benefit.
- Journal
- Annals of surgical oncology (Q1)
- Published
- 4 November 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Neel NC, Acharya K, Van Doosselaere L, Raclin N, Ahdoot A, Frederick D, et al.
- PMID
- 42980923
- DOI
- 10.1245/s10434-026-20722-0
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 8 November 2026): CRS/HIPEC meta-analysis informs selective diversion after pelvic anastomosis
Abstract
BACKGROUND: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an established treatment for peritoneal surface malignancies, but is associated with substantial morbidity, particularly when pelvic anastomoses are performed. Diverting ostomies are commonly used to mitigate complications related to anastomotic leak; however, ostomy formation carries its own morbidity, and its benefit in this setting remains controversial. PATIENTS AND METHODS: PubMed and Embase were queried for studies of patients undergoing CRS/HIPEC with a pelvic anastomosis, documented use of diverting ostomy, and reported anastomotic leak rates. Eligible studies required combined CRS/HIPEC, explicit reporting of diversion status, and perioperative outcomes stratified by ostomy presence. Abstracts were independently screened by two reviewers, followed by full-text review for final inclusion. A binary odds ratio meta-analysis was performed comparing anastomotic leak between diverted and non-diverted patients. RESULTS: Of 506 studies identified, 10 met inclusion criteria and were combined with our institutional cohort, comprising 1506 patients. Overall, diversion was not associated with a statistically significant reduction in anastomotic leak (OR 0.67, 95% CI 0.32-1.39, p = 0.28). No differences were observed in grade ≥ 3 complications or length of stay. Diversion was associated with increased 60-day readmissions (OR 3.29, 95% CI 1.52-7.11, p < 0.01). CONCLUSIONS: Diverting ostomies were not associated with a statistically significant reduction in anastomotic leak in patients undergoing CRS/HIPEC with a pelvic anastomosis. These findings suggest consideration of a selective, rather than routine, diversion strategy in appropriately selected patients.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.