Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery

• Published in: Annals of surgical oncology Vol. 31; no. 1; pp. 645 - 654
• Main Authors: Vierra, Mason, Bansal, Varun V., Morgan, Ryan B., Witmer, Hunter D. D., Reddy, Biren, Dhiman, Ankit, Godley, Frederick A., Ong, Cecilia T., Belmont, Erika, Polite, Blasé, Shergill, Ardaman, Turaga, Kiran K., Eng, Oliver S.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.01.2024; Springer Nature B.V
• Subjects: Adenocarcinoma; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Appendiceal Neoplasms - drug therapy; Appendiceal Neoplasms - surgery; Appendix; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - surgery; Combined Modality Therapy; Cytoreduction Surgical Procedures; Gastrointestinal cancer; Humans; Hyperthermia, Induced - adverse effects; Malignancy; Medicine; Medicine & Public Health; Metastases; Metastasis; Oncology; Patients; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - surgery; Peritoneal Surface Malignancy; Peritoneum; Peritoneum - pathology; Retrospective Studies; Surgery; Surgical Oncology; Survival; Survival Rate; Chemotherapy; Colorectal neoplasms; HIPEC; Appendiceal neoplasms; Cytoreductive surgery
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-023-14318-1

Background The delivery of multimodal treatment at a high-volume center is known to optimize the outcomes of gastrointestinal malignancies. However, patients undergoing cytoreductive surgery (CRS) for peritoneal metastases often must ‘fragment’ their surgical and systemic therapeutic care between different institutions. We hypothesized that this adversely affects outcomes. Patients and Methods Adults undergoing CRS for colorectal or appendiceal adenocarcinoma at our institution between 2016 and 2022 were identified retrospectively and grouped by care network: ‘coordinated care’ patients received exclusively in-network systemic therapy, while ‘fragmented care’ patients received some systemic therapy from outside-network providers. Factors associated with fragmented care were also ascertained. Overall survival (OS) from CRS and systemic therapy-related serious adverse events (SAEs) were compared across the groups. Results Among 85 (80%) patients, 47 (55%) had colorectal primaries and 51 (60%) received fragmented care. Greater travel distance [OR 1.01 (CI 1.00–1.02), p = 0.02] and educational status [OR 1.04 (CI 1.01–1.07), p = 0.01] were associated with receiving fragmented care. OS was comparable between patients who received fragmented and coordinated care in the colorectal [32.5 months versus 40.8 months, HR 0.95 (CI 0.43–2.10), p = 0.89] and appendiceal [31.0 months versus 27.4 months, HR 1.17 (CI 0.37–3.74), p = 0.55] subgroups. The frequency of SAEs (7.8% versus 17.6%, p = 0.19) was also similar. Conclusions There were no significant differences in survival or SAEs based on the networks of systemic therapy delivery. This suggests that patients undergoing CRS at a high-volume center may safely receive systemic therapy at outside-network facilities with comparable outcomes.