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

  • Peritoneal Surface Malignancy
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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.

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Funding

Supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR002382 / UL1TR002378 and the Katz Foundation.

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Authors and Affiliations

  1. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Adriana C. Gamboa MD, Mohammad Y. Zaidi MD, MS, Rachel M. Lee MD, MSPH, Shelby Speegle MA, Maria C. Russell MD, Charles A. Staley MD & Shishir K. Maithel MD

  2. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Jeffrey M. Switchenko PhD & Joseph Lipscomb PhD

  3. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jordan M. Cloyd MD & Ahmed Ahmed MD

  4. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA

    Travis Grotz MD & Jennifer Leiting MD

  5. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Keith Fournier MD & Andrew J. Lee MD

  6. Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Sean Dineen MD & Benjamin D. Powers MD, MS

  7. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA

    Andrew M. Lowy MD & Nikhil V. Kotha BS

  8. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Callisia Clarke MD & T. Clark Gamblin MD

  9. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Sameer H. Patel MD & Tiffany C. Lee MD

  10. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Laura Lambert MD & Ryan J. Hendrix MD

  11. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA

    Daniel E. Abbott MD & Kara Vande Walle MD

  12. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

    Kelly Lafaro MD & Byrne Lee MD

  13. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA

    Fabian M. Johnston MD, MHS & Jonathan Greer MD

Authors
  1. Adriana C. Gamboa MD
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  2. Mohammad Y. Zaidi MD, MS
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  3. Rachel M. Lee MD, MSPH
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  4. Shelby Speegle MA
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  5. Jeffrey M. Switchenko PhD
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  6. Joseph Lipscomb PhD
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  7. Jordan M. Cloyd MD
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  8. Ahmed Ahmed MD
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  9. Travis Grotz MD
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  10. Jennifer Leiting MD
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  11. Keith Fournier MD
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  12. Andrew J. Lee MD
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  13. Sean Dineen MD
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  14. Benjamin D. Powers MD, MS
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  15. Andrew M. Lowy MD
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  16. Nikhil V. Kotha BS
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  17. Callisia Clarke MD
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  18. T. Clark Gamblin MD
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  19. Sameer H. Patel MD
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  20. Tiffany C. Lee MD
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  21. Laura Lambert MD
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  22. Ryan J. Hendrix MD
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  23. Daniel E. Abbott MD
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  24. Kara Vande Walle MD
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  25. Kelly Lafaro MD
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  26. Byrne Lee MD
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  27. Fabian M. Johnston MD, MHS
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  28. Jonathan Greer MD
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  29. Maria C. Russell MD
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  30. Charles A. Staley MD
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  31. Shishir K. Maithel MD
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Correspondence to Shishir K. Maithel MD.

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Gamboa, A.C., Zaidi, M.Y., Lee, R.M. et al. Optimal Surveillance Frequency After CRS/HIPEC for Appendiceal and Colorectal Neoplasms: A Multi-institutional Analysis of the US HIPEC Collaborative. Ann Surg Oncol 27, 134–146 (2020). https://doi.org/10.1245/s10434-019-07526-1

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