P6: Survival Outcomes of Cytoreductive Surgery with HIPEC in Gastric Adenocarcinoma: A National Cancer Database Study

Sunday, February 18, 2024

8:50 AM - 8:55 AM AST

Location: Miramar I & II

Oral Poster Presenter(s)

Andrii Khomiak, MD

Resident - General Surgery
University of Colorado Anschutz Medical Campus, United States

Submitter(s)

Andrii Khomiak, MD

Resident - General Surgery
University of Colorado Anschutz Medical Campus, United States

Author(s)

Andrii Khomiak, MD

Resident - General Surgery
University of Colorado Anschutz Medical Campus, United States
Salvador Rodriguez Franco, MD (he/him/his)

Senior Research Associate
University of Colorado Anschutz Medical Campus
Aurora, Colorado, United States
IZ

Ioannis A. Ziogas, MD, MPH

Resident - General Surgery
University of Colorado Anschutz Medical Campus
Aurora, Colorado, United States
Elliott J. Yee, MD (he/him/his)

General Surgery Resident
University of Colorado - Anschutz, CO
Denver, Colorado, United States
SG

Sumaya Abdul Ghaffar, MD

Research Fellow
University of Colorado, United States
Oskar Franklin, MD, PhD

Visiting Research Fellow
University of Colorado Anschutz Medical Campus, Department of Sugery, Division of Surgical Oncology
Englewood, Colorado, United States
EC

Ethan Cumbler, MD

Professor
University of Colorado Anschutz Medical Campus, United States
AC

Akshay Chauhan, MD

Associate Professor
University of Colorado Anschutz Medical Campus, United States
Martin D. McCarter, MD

Professor of Surgery
University of Colorado, Department of Surgery, United States
AG

Ana L. Gleisner, MD, PhD

Associate Professor of Surgery
University of Colorado, United States
Steven Ahrendt, MD

Professor
University of Colroado
Aurora, Colorado, United States
MD

Marco Del Chiaro, MD, PhD

Division Chief Surgical Oncology
University of Colorado Anschutz Medical Campus, United States
RS

Richard D. Schulick, MD, MBA

Chair of Surgery and Cancer Center Director
University of Colorado, Department of Surgery, United States
BM

Benedetto Mungo, MD

Assistant Professor of Surgery
University of Colorado, Department of Surgery, United States

Disclosure(s):

Andrii Khomiak, MD: No financial relationships to disclose

Salvador Rodriguez Franco, MD: No financial relationships to disclose

Introduction:

Peritoneal carcinomatosis in gastric adenocarcinoma represents a grim prognosis, with limited therapeutic options as per current guidelines. This study aims to assess the impact of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) on the survival outcomes for patients with gastric cancer and peritoneal carcinomatosis.

Methods:

A retrospective analysis of the National Cancer Database (NCDB) from 2004 to 2020 identified patients with topography and histology codes consistent with gastric adenocarcinoma. We included patients who underwent CRS/HIPEC as defined by relevant values in the "Surgical Procedure of Primary Site" and intraoperative chemotherapy administration in "Systemic Surgery Sequence" columns within the NCDB. Exclusions comprised known distant metastasis to liver, brain, bones or lungs and missing key data on staging, procedure or follow-up. We compared the CRS/HIPEC group to patients with stage IV disease receiving systemic chemotherapy but no surgery to the primary site. Survival probabilities were estimated through Kaplan-Meier Survival Analysis, while Hazard Ratios (HRs) were computed using Cox Regression analysis.

Results:

The study included 148 patients who underwent CRS/HIPEC. Mean age was 56.4 ± 12.9 years, with 57.4% being male and 73.6% identifying as white. Most CRS/HIPEC patients had locally advanced disease with 33.8% having pT4 disease, and 23% patients with pN3 status. Charlson-Deyo Scores were 0 and 1 for 77% and 16.9% of patients, respectively. In multivariate analysis, CRS/HIPEC was associated (p< .05) with age < 65 years OR 1.7 (95% CI 1.2-2.5) and academic facility type OR 2.3 (95% CI 1.3-3.9). Survival analysis comparing patients with stage IV disease who underwent CRS/HIPEC to systemic chemotherapy indicated significantly improved outcomes for the HIPEC cohort, with a median survival of 18.1 vs 9.2 months (p< .001) and 1-year overall survival (OS) of 72.6% vs 38.8% (p< 0.05). For stage IV patients, when controlling for Charlson Deyo score, histology, age, and sex, CRS/HIPEC showed improved survival compared to systemic chemotherapy with HR 1.9 (95% CI 1.5-2.4, p< .001).

Conclusions:

The results demonstrate the association of CRS/HIPEC with improved survival in patients with gastric adenocarcinoma and peritoneal disease. Some of this difference may be due to selection bias, but the differences in survival curves are robust.

Learning Objectives:

Upon completion, participant will be equipped to discuss the demographic and clinical characteristics of patients who underwent CRS/HIPEC.
Upon completion, participant will be able to understand the association of CRS/HIPEC with survival outcomes in gastric cancer patients with peritoneal carcinomatosis and relevant study limitations.
Upon completion, participant will be able to describe study's methodology, including data collection, patient selection criteria, and analysis techniques.