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

• Authors: Adriana C. Gamboa, Emory University; Mohammad Y. Zaidi, Emory University; Rachel M. Lee, Emory University; Shelby Speegle, Emory University; Jeffrey Switchenko, Emory University; Joseph Lipscomb, Emory University; Jordan M. Cloyd, Ohio State University; Ahamed Ahmed, Ohio State University; Travis Grotz, Mayo Clinic; Jennifer Leiting, Mayo Clinic; Keith Fournier, University of Texas MD Anderson Cancer Center; Andrew J. Lee, University of Texas MD Anderson Cancer Center; Sean Dineen, H. Lee Moffitt Cancer Center; Benjamin D. Powers, H. Lee Moffitt Cancer Center; Andrew M. Lowy, University of California, San Diego; Nikhil V. Kotha, University of California, San Diego; Callisia Clarke, Medical College of Wisconsin; T. Clark Gamblin, Medical College of Wisconsin; Sameer H. Patel, University of Cincinnati; Tiffany C. Lee, University of Cincinnati; Laura Lambert, University of Massachusetts Medical School; Ryan J. Hendrix, University of Massachusetts Medical School; Daniel E. Abbott, University of Wisconsin; Kara Vande Walle, University of Wisconsin; Kelly Lafaro, City of Hope National Medical Center; Byrne Lee, City of Hope National Medical Center; Fabian M. Johnston, Johns Hopkins University; Jonathan Greer, Johns Hopkins University; Maria Russell, Emory University; Charles Staley, Emory University; Shishir Maithel, Emory University
• Journal Title: ANNALS OF SURGICAL ONCOLOGY
• Volume: Volume 27, Number 1
• Publisher: SPRINGER | 2020-01-01, Pages 134-146
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1245/s10434-019-07526-1
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Surgery; HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY; COMPLETE CYTOREDUCTIVE SURGERY; FOLLOW-UP; PERITONEAL CARCINOMATOSIS; SYSTEMIC CHEMOTHERAPY; RANDOMIZED-TRIAL; PSEUDOMYXOMA PERITONEI; CURATIVE RESECTION; CANCER; RECURRENCE

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.