Treatment outcomes and prognostic factors of bowel function recovery after hyperthermic intraperitoneal chemotherapy and cytoreductive surgery for metastatic cancers of the abdomen and pelvis.

Sidra Naz The University of Texas MD Anderson Cancer Center, Houston, TX info_outline Sidra Naz, Jianliang Dai, Irene Jeong-AH Lee, Ahmed F. Sayed, Beth A. Helmink, Mehnaz Shafi

Authors Sidra Naz The University of Texas MD Anderson Cancer Center, Houston, TX info_outline Sidra Naz, Jianliang Dai, Irene Jeong-AH Lee, Ahmed F. Sayed, Beth A. Helmink, Mehnaz Shafi Organizations The University of Texas MD Anderson Cancer Center, Houston, TX, Baylor College of Medicine, Houston, TX, The University of Texas MD Anderson Cancer Center, Hosuton, TX Abstract Disclosures Research Funding No funding sources reported Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is combined with cytoreductive surgery (CRS) to treat metastatic tumors of the abdomen and pelvis. The risk factors of GI dysmotility after HIPEC and CRS are not well known. Methods: We performed a single-center, retrospective chart review including all patients who had undergone HIPEC and CRS for metastatic cancer of the abdomen and pelvis from 2016-2023 to assess the prognostic factors of bowel function after HIPEC and CRS treatment. Patients were classified into high or low peritoneal cancer burden by a peritoneal cancer index (PCI) score. Statistics: Categorical variables were summarized by count and percentage and continuous variables. Comparisons of categorical and continuous covariables were conducted using Fisher’s exact test and the Wilcoxon rank sum test. Results: 195 patients met the study criteria. Duration of bowel recovery time in the High PCI was significantly higher than in the Low PCI group (median 11.5 days vs 9 days, p = 0.027). Persistent bowel dysfunction at day 30 was (7.47 x) associated with malnutrition (p = 0.001) and (6.95 x) a venting G Tube (p = 0.032) and history of radiation (p = 0.019) and Pre-OP Opioid Use (p = 0.01). Metoclopramide, Erythromycin and Mu Antagonists were used in 32%, 4.7% and 1.2% respectively of patients with bowel dysfunction. Conclusions: Patients with a high PCI score had a statistically significant longer duration of bowel dysfunction. Malnutrition and a history of radiation were statistically higher in patients with prolonged bowel dysfunction. Use of prokinetics and mu receptor antagonists was uncommon. Small bowel obstruction (SBO) diagnosis and related characteristics by immediate post-op bowel function (30-day period). Variable Level Overall Bowel Function (30) P-value Yes No N 197 44 105 DX, n(%) SBO 56 (55.4) 13 (35.1) 25 (65.8) 0.011 LBO 2 (2.0) 0 (0.0) 0 (0.0) Ileus 43 (42.6) 24 (64.9) 13 (34.2) Abnormal CT Scan, n(%) Yes 55 (31.4) 17 (39.5) 17 (16.2) 0.004 No 120 (68.6) 26 (60.5) 88 (83.8) Recurrent HIPEC, n(%) Yes 29 (15.8) 10 (22.7) 4 (3.8) 0.001 No 154 (84.2) 34 (77.3) 101 (96.2) Recurrence Bowel Dysfunction, n(%) Yes 32 (18.3) 15 (34.1) 4 (3.8) < 0.001 No 143 (81.7) 29 (65.9) 101 (96.2) DX: Diagnosis, SBO: Small bowel obstruction, LBO: Large bowel obstruction, HIPEC: Hyperthermic intraperitoneal chemotherapy.