Surgical management of peritoneal metastases from appendix and colon cancer in patients with inflammatory bowel disease

Background

Inflammatory bowel disease (IBD) may compromise outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal metastases (PM) from appendix/colon cancer. We evaluated CRS/HIPEC outcomes in patients with concurrent IBD.

Methods

A matched cohort study using a prospective institutional CRS/HIPEC database (1998–2023) included appendix/colon cancer patients with PM. We matched IBD patients to IBD-free controls in a 1:5 ratio with nearest-neighbor propensity score for sex, age, and peritoneal cancer index (PCI), and exact matching for prior CRS/HIPEC and primary tumor. Perioperative variables, including Clavien-Dindo 90-day complications, were compared. Kaplan-Meier overall (OS) and progression-free survival (PFS) were compared using stratified Cox regression.

Results

Of 605 CRS/HIPECs for appendix/colon cancer, 14 (2.3%) had concurrent Crohn’s disease (n = 6) or ulcerative colitis (n = 8). Seventy IBD-free controls were matched. Nine (64.7%) IBD patients had an appendix primary. Complete cytoreduction (CC-0/1) was achieved in 10 (71.4%) IBD and 57 (81.4%) IBD-free patients (p = 0.468). IBD vs IBD-free patients tended to have more grade-III/IV complications (35.7% [n = 5] vs 15.7% [n = 11], p = 0.082) and had a higher rate of severe nausea/vomiting (35.7% vs 4.3 %, p < 0.001) and diarrhea (28.6% vs 8.6%, p = 0.035). Rates of anastomotic leak (7.1% [n = 1] vs 1.4% [n = 1], p = 0.200) and intraabdominal infections (7.1% [n = 1] vs 2.9% [n = 2], p = 0.430) were similar for IBD vs IBD-free, respectively. IBD did not affect OS (HR [95% CI]: 1.1 [0.4, 2.9]) or PFS (HR [95% CI]: 1.2 [0.4, 3.9]).

Conclusion

IBD is associated with a higher rate of gastrointestinal complications after CRS/HIPEC for appendix/colon cancer; however, it does not affect OS or PFS.