Meeting
2020 Gastrointestinal Cancers Symposium
Implications of postoperative complications on survival after cytoreductive surgery and HIPEC: A multi-institutional analysis of the United States HIPEC Collaborative.
Authors
Adriana C. Gamboa
Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA
Adriana C. Gamboa , Rachel M. Lee , Michael K. Turgeon , Ahmed Ahmed , Travis Edward Grotz , Keith F. Fournier , Sean Patrick Dineen , Jula Veerapong , Callisia Clarke , Harveshp Mogal , Sameer H. Patel , Laura A. Lambert , Daniel Erik Abbott , Mustafa Raoof , Fabian McCartney Johnston , Jordan Cloyd , Shishir K. Maithel , Charles A. Staley
Organizations
Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, Winship Cancer Institute, Emory University, Atlanta, GA, Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, University of Cincinnati, Cincinnati, OH, Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, Department of Surgery, Johns Hopkins University, Baltimore, MD, Emory University, Atlanta, GA
Research Funding
Other
Katz Foundation
Background: Postoperative complications (POCs) are associated with worse oncologic outcomes in various cancer histologies. The impact of POCs on the survival of patients with appendiceal or colorectal cancer after cytoreductive surgery/heated intraperitoneal chemotherapy (CRS/HIPEC) is unknown. Methods: US HIPEC Collaborative (2000-17) was reviewed for patients who underwent CCR0/1 CRS/HIPEC for appendiceal/colorectal cancer. Analysis was stratified by non-invasive appendiceal neoplasm vs invasive appendiceal/colorectal adenocarcinoma. POCs were grouped into infectious, cardiopulmonary, thromboembolic and intestinal dysmotility. Primary outcomes were 3-yr overall survival (OS) and recurrence-free survival (RFS). Results: Of 1304 pts, median age was 55 yrs, 41% were male (n = 537), 33% had non-invasive appendiceal (n = 426) and 67% had invasive appendiceal/colorectal adenocarcinoma (n = 878). In the non-invasive appendiceal cohort, POCs were identified in 55% (n = 233) and OS and RFS did not differ between patients who experienced a complication and those who did not (OS 94 vs 94% p = 0.26; RFS 68 vs 60% p = 0.15). In the invasive appendiceal/colorectal adenocarcinoma cohort, however, POCs (63%; n = 555) were associated with decreased OS (59 vs 74% p < 0.001) and RFS (32 vs 42% p < 0.001). Infectious POCs were most common (35%; n = 196). On MV analysis accounting for gender, PCI and incomplete resection (CCR1), infectious POCs in particular were associated with decreased OS compared to no complication (HR 2.08 95%CI 1.48-2.93 p < 0.01) or other types of complications (HR 1.7 95%CI 1.28-2.25 p < 0.01). This association persisted for infectious POCs and reduced RFS (HR 1.61 95%CI 1.23-2.10 p < 0.01). Conclusions: Postoperative complications are associated with decreased OS and RFS after CRS/HIPEC for invasive histology, but not for an indolent disease like non-invasive appendiceal neoplasm. Of all complication types, infectious complications are the main driver for this association. The exact mechanism is not known, but may be immunologic. Efforts must target best practices and standardized prevention strategies to minimize infectious POCs.
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Abstract Details
Session Type
Poster Session
Session Title
Poster Session C: Anal and Colorectal Cancer
Track
Colorectal Cancer,Anal Cancer
Sub Track
Patient-Reported Outcomes and Real-World Evidence
Citation
J Clin Oncol 38, 2020 (suppl 4; abstr 40)
Abstract #
40
Poster Bd #
B12
Abstract Disclosures
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