Inflammatory Bowel Disease in Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Oncology

Background:

• Inflammatory bowel diseases (IBD) increase gastrointestinal cancer risk, often with worse prognoses.
• Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) is a treatment for peritoneal metastases.
• Limited data exists on CRS/HIPEC outcomes in IBD patients.

Purpose of the Study:

• To compare short-term and oncological outcomes of CRS/HIPEC in patients with and without IBD.
• To evaluate the safety and efficacy of CRS/HIPEC in the IBD population.

Main Methods:

• Retrospective review of a prospectively maintained CRS/HIPEC database.
• Comparison of short-term outcomes (hospital stay, complications, reoperations) and oncological outcomes (recurrence, OS, DFS) between IBD and non-IBD cohorts.
• Analysis of 232 patients, including 10 with IBD, who underwent CRS/HIPEC for adenocarcinoma.

Main Results:

• Patients with IBD had different demographic profiles (lower ASA, less hypertension, higher small bowel primary) but similar peritoneal cancer index (PCI) and extent of surgery.
• Short-term outcomes including complication rates (60.3% overall, 21.2% major) and reoperation rates (27%) were similar between IBD and non-IBD groups.
• Median overall survival (OS) was 19.6 months for IBD vs 53.2 months for non-IBD (p=0.056). Median disease-free survival (DFS) was 4.9 months for IBD vs 9.4 months for non-IBD (p=0.174).

Conclusions:

• CRS/HIPEC in IBD patients demonstrates a similar complication profile to non-IBD patients.
• Oncological outcomes trended towards being poorer in the IBD cohort compared to the non-IBD cohort.
• CRS/HIPEC may be a viable option for selected IBD patients, but outcomes warrant careful consideration.