E217: Incomplete Cytoreduction and Major Hepatectomy are Associated with Worse Survival in Patients Undergoing Combined Cytoreductive Surgery and Hepatectomy for Metastatic Colorectal Cancer

ePoster Abstract Author(s)

Reed I. Ayabe, MD

Complex General Surgical Oncology Fellow
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Submitter(s)

Reed I. Ayabe, MD

Complex General Surgical Oncology Fellow
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Author(s)

Reed I. Ayabe, MD

Complex General Surgical Oncology Fellow
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
KB

Karen Beaty, PA-C

Physicians Assistant
The University of Texas MD Anderson Cancer Center, United States
Timothy E. Newhook, MD

Assistant Professor of Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
YC

Yun Shin Chun, MD

Professor of Surgery
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Hop S. Tran-Cao, M.D. (he/him/his)

Associate Professor
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Ching-Wei D. Tzeng, MD (he/him/his)

Associate Professor of Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Christopher P. Scally, M.D.

Assistant Professor
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA, United States
Beth A. Helmink, M.D. Ph.D. (she/her/hers)

Assistant Professor
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA
Houston, Texas, United States
PM

Paul F. Mansfield, MD

Professor
MD Anderson Cancer Center, United States
Jean-Nicolas Vauthey, MD (he/him/his)

Professor of Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
KF

Keith F. Fournier, MD

Associate Professor
Division of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, United States, United States
Michael G. White, MD, M.Sc.

Assistant Professor
Department of Colon & Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston TX, USA
Houston, Texas, United States

Introduction: Peritoneal dissemination is traditionally viewed as a contraindication to curative-intent hepatectomy for colorectal liver metastasis (CLM). However, aggressive surgical extirpation of both disease sites may benefit select patients. We sought to evaluate the safety and oncologic outcomes of combined cytoreductive surgery (CRS) and hepatectomy for metastatic colorectal cancer at a single, high-volume institution.

Methods: A prospectively maintained database was queried for patients who underwent combined CRS and hepatectomy for metastatic colorectal cancer. Clinicopathologic, molecular, and treatment-related variables were evaluated for associations with survival.

Results: A total of 41 patients were identified who underwent combined CRS/hepatectomy from 2009-2022. The median age was 52 years, and the majority of patients were male (25, 61%). The median peritoneal carcinomatosis index (PCI) was 5 (IQR 2-14) and the median size and number of liver metastases were 17 mm (IQR 9-29) and 2 (IQR 1-3), respectively. Twenty patients (49%) harbored somatic KRAS mutations, of whom 10 (24%) were also co-mutant in TP53. Hyperthermic intraperitoneal chemotherapy (HIPEC) was utilized in 14 (34%) cases and major hepatectomy was performed in 8 (20%) cases. A completeness of cytoreduction (CCR) score of 0 and R0 liver resection were achieved in 32/37 (85%) and 33/36 (92%) patients, respectively. Perioperative Accordion grade ≥3 complications occurred in 2 patients (5%) and the 30-day readmission rate was 11%. At a median 27 months of follow-up, median progression-free and overall survival (OS) were 5.2 months and 31.5 months, respectively. The liver was the most common site of disease recurrence (n=19, 46%) followed by the peritoneum (n=14, 34%), and lungs (n=10, 24%). On multivariate analysis, CCR ≥1 (HR 2.1 [95%CI 1.0-9.7]) and major hepatectomy (HR 1.62 [95%CI 1.1-6.3]) were independently associated with shorter overall survival (OS) (Figure).

Conclusions: Combined CRS/hepatectomy can be performed safely and is associated with favorable oncologic outcomes in appropriately selected patients. The likelihood of complete cytoreduction and the need for major hepatectomy should be considered when selecting patients for these extensive operations.

Learning Objectives:

Describe the different management options and challenges associated with colorectal tumors that have spread to both the liver and peritoneum.
Describe outcomes associated with combined cytoreductive surgery (with and without HIPEC) and hepatectomy for metastatic colorectal cancer.
Discuss the prognostic impact of incomplete cytoreduction and extent of hepatectomy on survival in patients who have undergone combined cytoreductive surgery and hepatectomy for metastatic colorectal cancer.