E367: Early Experience and Quality Outcomes from a Community Peritoneal Surface Malignancies Program

The management of patients with peritoneal surface disease is complex and requires a multidisciplinary team and rigorous monitoring of outcomes. Quality metrics have been previously reported by the Chicago Consensus Working Group (CCWG). Establishing a new peritoneal malignancies program in a community setting requires extensive preparation, including the development of perioperative management protocols, staff training at all phases of care, identification of team leaders, frequent assessment of results and periodic team meetings.

Methods:

All patients treated during the first 15 months of a newly established peritoneal surface disease program at a community cancer center were analyzed. Only patients who underwent a curative-intent cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy were included. The primary focus of this analysis was to assess the quality outcomes as described by CCWG.

Results:

After more than six months of preparation and in close partnerships with well-established peritoneal malignancies programs, we  performed our first CRS/HIPEC with a physician proctor present. Ten patients underwent cytoreductive surgery from 3/2022 until 6/2023, eight with hyperthermic intraperitoneal chemotherapy and two without. The primary diagnosis was low-grade appendiceal adenocarcinoma (4/10), colon adenocarcinoma (3/10), high-grade serous ovarian (1/10), high-grade appendiceal adenocarcinoma (1/10), small bowel adenocarcinoma (1/10). The average age was 53 and 6/10 were female, average length of stay was 7 days and there were no readmissions. One patient had a CT-guided drain placed for an intra-abdominal abscess, Clavien-Dindo III or higher complication rate was 10% and there was no 90-day mortality. No patients had to have a colostomy or ileostomy, transfusion rate was 20% and the rate of complete cytoreduction (CC0/CC1) was 80%.   

Conclusions:

Rigorous monitoring of quality metrics is essential, particularly for new programs managing patients with peritoneal surface malignancies. Our early experience from a community cancer center is in accordance with the quality metrics described by CCWG. Additional long-term outcomes with particular emphasis to survival and quality of life need to be carefully monitored.