Peritoneal Surface Malignancies
Javid Sadjadi, MD
Fellow
University of New Mexico
Albuquerque, New Mexico, United States
Javid Sadjadi, MD
Fellow
University of New Mexico
Albuquerque, New Mexico, United States
Javid Sadjadi, MD
Fellow
University of New Mexico
Albuquerque, New Mexico, United States
Li Luo, PhD
Associate Professor
University of New Mexico Health Sciences Center, United States
Yazmin Irazoqui Ruiz, MD
Resident
University of New Mexico Health Sciences Center, United States
Bridget N. Fahy, MD (she/her/hers)
Professor
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
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Alissa Greenbaum, MD
Assistant Professor
University of New Mexico Comprehensive Cancer Center
Albuquerque, New Mexico, United States
Malignant peritoneal mesothelioma (MPM) is a rare disease with a generally poor response to systemic chemotherapy. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has been reported to result in 5-year survival of 39-91.3% and is often regionalized at tertiary referral centers. The aim of this study is to examine the effect of travel distance on oncologic and postoperative outcomes in patients with MPM undergoing CRS-HIPEC.
Methods:
The National Cancer Database (NCDB) was reviewed from 2006-2020 for patients with MPM undergoing CRS-HIPEC. The primary variable was distance traveled to treating facility (< 50 miles versus ≥50 miles). Secondary variables included patient demographics, Charlson-Deyo scores, treating center type and location, and tumor characteristics. Primary outcome was overall survival. Secondary outcomes were 30-day and 90-day survival, 30-day readmission, and hospital length of stay (LOS) after operation. Fisher’s exact test and Wilcoxon rank sum test were used to compare groups and P value of < 0.05 is considered statistically significant.
Results:
During the study period, 650 patients met inclusion criteria. Rates of MPM were highest in the Northeast, Middle and South Atlantic regions. Most patients had epithelioid histology (67%), 3.7% were biphasic, 0.5% fibrous and 29% had unknown type. 345 patients traveled < 50 miles for CRS-HIPEC and 305 patients traveled ≥ 50 miles. Patients traveling ≥50 miles were more likely to be younger, privately insured, reside in a zip code with lower median income, and be treated at an academic center. Both travel groups had similar medical comorbidities and staging. There was no difference in overall survival between groups (Figure 1). Secondary outcomes were also comparable: 30-day survival was 98% in both groups (p=0.9), 90-day survival was 93% in both groups (p=0.9), 30-day readmission rate was 11% in the shorter travel distance group versus 7% (p=0.2). Hospital LOS was longer in the greater travel distance group 9 vs 8 days; p=0.02).
Conclusions: Overall and postoperative survival following CRS-HIPEC for MPM did not differ based upon distance traveled for treatment. Patients who travel ≥ 50 miles have an increased length of stay, perhaps reflecting provider desire for longer postoperative observation. Our study suggests that regionalization of CRS-HIPEC for MPM does not result in worse oncologic or surgical outcomes.