Disparities in Surgical Oncologic Care
Julia A. Brickey, MD (she/her/hers)
Resident Physician
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Julia A. Brickey, MD (she/her/hers)
Resident Physician
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Julia A. Brickey, MD (she/her/hers)
Resident Physician
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Deepa Magge, MD, FACS
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
David Hanna, MD
Resident Physician
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Muhammad B. Mirza, MD
Post-doctoral Research Fellow
Vanderbilt University Medical Center
nashville, Tennessee, United States
Nazanin Khajoueinejad, MD (she/her/hers)
Resident Physician
Mount Sinai School of Medicine
New York, New York, United States
As the indications for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) expand, several studies have recognized the effect of socioeconomic factors on perioperative outcomes. However, the role of race is unclear. The aim of this study was to identify racial disparities following CRS-HIPEC through a multi-institutional collaboration.
Methods:
We retrospectively reviewed the charts of 459 patients who underwent CRS-HIPEC at two high-volume, tertiary referral centers between 2007-2022. We grouped patients into white and non-white cohorts and compared patient demographics, tumor characteristics, and perioperative outcomes. Primary outcomes were time to surgery, disease-free survival (DFS), and overall survival (OS). Secondary outcomes included hospital length of stay, ICU admission, ICU length of stay, and the Clavien-Dindo complication score.
Results:
The white group was older (53.5 vs 48.6 years, p< 0.0003) and more likely to be insured (72.9% vs. 59.6%, p< 0.009) compared to the non-white group. The most common primary tumor in the white group was appendiceal (41.1%), whereas colorectal tumors (34.9%) were the most common in the non-white group. The groups were otherwise well matched regarding the peritoneal carcinomatosis index (PCI), tumor differentiation, lymphovascular/perineural invasion, and completeness of cytoreduction. There were no significant differences in time to surgery (12.5 vs. 16.6 months, p< 0.07), DFS (31.2 vs 25.7 months, p< 0.5), or OS (40.7 vs. 37.7 months, p< 0.7) between groups. Additionally, there were no significant differences among the secondary outcomes.
Conclusions:
Though it is well established that racial disparities exist within the field of surgical oncology, our study found similar perioperative outcomes after CRS-HIPEC when comparing white and non-white groups. However, this study was limited to patients who had already established care at a tertiary center, possibly excluding disparities that may occur at primary or secondary care junctions. Future studies should aim to capture patients with peritoneal malignancies who are not referred to high volume centers.