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Ann Surg Oncol. 2019 Jun 26. doi: 10.1245/s10434-019-07526-1. [Epub ahead of print]

Optimal Surveillance Frequency After CRS/HIPEC for Appendiceal and Colorectal Neoplasms: A Multi-institutional Analysis of the US HIPEC Collaborative.

Author information

1
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
2
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
3
Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
4
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA.
5
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
6
Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
7
Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA.
8
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
9
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
10
Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
11
Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA.
12
Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
13
Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
14
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA. smaithe@emory.edu.

Abstract

BACKGROUND:

No guidelines exist for surveillance following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for appendiceal and colorectal cancer. The primary objective was to define the optimal surveillance frequency after CRS/HIPEC.

METHODS:

The U.S. HIPEC Collaborative database (2000-2017) was reviewed for patients who underwent a CCR0/1 CRS/HIPEC for appendiceal or colorectal cancer. Radiologic surveillance frequency was divided into two categories: low-frequency surveillance (LFS) at q6-12mos or high-frequency surveillance (HFS) at q2-4mos. Primary outcome was overall survival (OS).

RESULTS:

Among 975 patients, the median age was 55 year, 41% were male: 31% had non-invasive appendiceal (n = 301), 45% invasive appendiceal (n = 435), and 24% colorectal cancer (CRC; n = 239). With a median follow-up time of 25 mos, the median time to recurrence was 12 mos. Despite less surveillance, LFS patients had no decrease in median OS (non-invasive appendiceal: 106 vs. 65 mos, p < 0.01; invasive appendiceal: 120 vs. 73 mos, p = 0.02; colorectal cancer [CRC]: 35 vs. 30 mos, p = 0.8). LFS patients had lower median PCI scores compared with HFS (non-invasive appendiceal: 10 vs. 19; invasive appendiceal: 10 vs. 14; CRC: 8 vs. 11; all p < 0.01). However, on multivariable analysis, accounting for PCI score, LFS was still not associated with decreased OS for any histologic type (non-invasive appendiceal: hazard ratio [HR]: 0.28, p = 0.1; invasive appendiceal: HR: 0.73, p = 0.42; CRC: HR: 1.14, p = 0.59). When estimating annual incident cases of CRS/HIPEC at 375 for non-invasive appendiceal, 375 invasive appendiceal and 4410 colorectal, LFS compared with HFS for the initial two post-operative years would potentially save $13-19 M/year to the U.S. healthcare system.

CONCLUSIONS:

Low-frequency surveillance after CRS/HIPEC for appendiceal or colorectal cancer is not associated with decreased survival, and when considering decreased costs, may optimize resource utilization.

PMID:
31243668
DOI:
10.1245/s10434-019-07526-1

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