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Multicenter Study
. 2020 Jan;27(1):134-146.
doi: 10.1245/s10434-019-07526-1. Epub 2019 Jun 26.

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

Adriana C Gamboa  1 , Mohammad Y Zaidi  1 , Rachel M Lee  1 , Shelby Speegle  1 , Jeffrey M Switchenko  2 , Joseph Lipscomb  2 , Jordan M Cloyd  3 , Ahmed Ahmed  3 , Travis Grotz  4 , Jennifer Leiting  4 , Keith Fournier  5 , Andrew J Lee  5 , Sean Dineen  6 , Benjamin D Powers  6 , Andrew M Lowy  7 , Nikhil V Kotha  7 , Callisia Clarke  8 , T Clark Gamblin  8 , Sameer H Patel  9 , Tiffany C Lee  9 , Laura Lambert  10 , Ryan J Hendrix  10 , Daniel E Abbott  11 , Kara Vande Walle  11 , Kelly Lafaro  12 , Byrne Lee  12 , Fabian M Johnston  13 , Jonathan Greer  13 , Maria C Russell  1 , Charles A Staley  1 , Shishir K Maithel  14
Affiliations
Multicenter Study

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

Adriana C Gamboa et al. Ann Surg Oncol. 2020 Jan.

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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Figures

FIG. 1
FIG. 1
Kaplan–Meier curves for overall survival comparing surveillance frequencies: a non-invasive appendiceal neoplasm, b invasive appendiceal neoplasm, c colorectal cancer
See this image and copyright information in PMC

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