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Gynecologic Oncology

Saturday Poster Presentations

P10: Small Bowel Obstruction and Ovarian Cancer: Insights from a Propensity-Score Matched Study in Patients with and without Hyperthermic Intraperitoneal Chemotherapy after Cytoreductive Surgery

Saturday, February 17, 2024
10:45 AM - 10:50 AM AST
Location: Miramar I & II
Disclosure(s):
Luis Felipe Falla-Zuniga, MD: No financial relationships to disclose
Introduction:

Small bowel obstruction (SBO) occurs in ~30% of ovarian cancer (OC) patients and is associated with readmission, debilitating symptoms, and death within one year of presentation. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective strategy for peritoneal disease control. We investigated the impact of CRS/HIPEC on SBO and obstruction-free survival (OFS) in primary OC patients.


Methods:

A retrospective (2014-2022) single-center cohort study of stage III/IV primary OC patients treated with optimal CRS with and without HIPEC was performed. Patients who underwent upfront CRS/HIPEC vs CRS alone were paired 1:1 with exact matching for histology (high-grade serous [HGS] vs non-HGS) and optimal propensity score matching (PSM) for age ( >65 years), FIGO stage (III vs IV), and surgery year. Kaplan-Meier overall (OS), progression-free (PFS), and OFS were compared using a stratified log-rank test. OFS was measured from surgery to SBO/death.


Results:

After PSM, 33 patients were included per group. American Society of Anesthesiologist score was similar between groups (p=0.4). CRS/HIPEC patients had longer median operative time (396 [IQR: 357-458] vs 301 [IQR: 234-396] minutes, p< 0.01), higher bowel resection with anastomosis rates (87.9% [n=29] vs 48.5% [n=16], p< 0.01), and longer median hospital stay (10 [IQR: 9-13] vs 7 [IQR: 5-12] days, p< 0.01). Clavien-Dindo 90-day major postoperative complications (p=0.07) and mortality rates (p=1.00) were similar between groups. After median follow up of 61.3 months, SBO occurred in 18.2% (n=6) CRS/HIPEC vs 39.4% (n=13) CRS only patients (p=0.08). The majority of SBO were diagnosed by abdominal CT (CRS/HIPEC: 83.3% [n=5], CRS: 76.9% [n=10]), a partial obstruction (CRS/HIPEC: 66.7% [n=4], CRS: 53.8% [n=7]), and managed conservatively (CRS/HIPEC: 66.7% [n=4], CRS: 76.9% [n=10]). Median OFS was 71.6 (95%CI: 30.89-not reached) vs 20.0 (95%CI: 6.7-49.8) months (p=0.03). Median time to death after initial SBO was 64.3 vs 36.2 months (p=0.08) with a 1-year survival rate of 83.3% vs 69.2%, respectively. CRS/HIPEC patients had a significantly longer 5-year PFS (44.0% vs 8.0%, p< 0.01), but not OS (71.6% vs 39.6%, p=0.06) (Figure 1).


Conclusions:

SBO after CRS/HIPEC for upfront OC is not uncommon; however, it occurred less frequently, was delayed, and had a lower 1-year mortality compared to CRS alone. The addition of HIPEC can provide long-term peritoneal disease control in OC patients. Prospective clinical trials are needed.  

Learning Objectives:

  • 1) To describe the potential benefit on obstruction-free survival of adding hyperthermic intraperitoneal chemotherapy (HIPEC) to upfront cytoreductive surgery (CRS) for treatment of peritoneal carcinomatosis from ovarian cancer.
  • 2) To compare the impact that small bowel obstruction has on the outcomes of advanced ovarian cancer patients undergoing upfront cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC).
  • 3) To identify the characteristics and management of small bowel obstruction episodes experienced by ovarian cancer patients after upfront cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC).