(PM P20) National Trends In Cytoreductive Surgery with Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Origin: An Analysis of the National Cancer Database

Background: Preliminary data from the PRODIGE 7 study has questioned the benefit for intraperitoneal chemotherapy (IPC) in management of peritoneal carcinomatosis secondary to colorectal cancer (CRC). We sought to evaluate trends and survival outcomes of patients in the United States undergoing CRS-IPC using the National Cancer Database (NCDB). Materials and methods: CRS-IPC cases for colorectal cancer were extracted from the NCDB (2004-2016). The number of operations were analyzed for four time periods—2004-2007, 2008-2010 and 2011-2013, and 2014-2016.

Results: A total of 2,459 patients underwent CRS-IPC for CRC with 96% of cases performed for colon cancer. Median age was 55 years with 50.4% female. Operations were most often performed at academic centers (60%) or comprehensive community cancer programs (18%). There was an increase in the number of CRS-IPC performed for all institutions in the study period (p=0.001). The use of CRS-IPC increased over subsequent time periods for patients with intermediate/poorly differentiated tumors (4%, 19%, 29%, and 43%, p=0.002) but not those with lymph node positive disease or LVI (p>0.05). Median overall survival for the entire cohort was 53.0 months and remained stable over time (median OS 56.6mo, 92.2mo, 76.2mo, and NR p=0.07).

Conclusions: There has been an increase in the number of CRS-IPC cases performed for CRC in the US over the last decade. Furthermore, CRS-IPC is increasingly being performed for patients with more biologically aggressive disease without poorer outcomes. The role of CRS-IPC needs further investigation, and data from the PRODIGE 7 study should be interpreted with caution.