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Monday Poster Session

Category: Small Intestine

P2628 - Risk Factors of Prolonged Bowel Dysfunction After Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery for the Treatment of Metastatic Tumors of the Abdomen and Pelvis

Monday, October 23, 2023
10:30 AM – 4:15 PM PT
Location: Exhibit Hall
Sidra Naz, MD, MPH1, Ahmed Sayed Ahmed, MBBCh2, Jianliang Dai, 3, Irene Lee, MD4, Beth Helmink, MD, PhD3, Mehnaz A. Shafi, MD3
1University of Texas MD Anderson Cancer Center, Houston, TX; 2University of Texas, MD Anderson Cancer Center, Houston, TX; 3UT MD Anderson Cancer Center, Houston, TX; 4Baylor College of Medicine, Houston, TX

Introduction: Hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS) is used to treat metastatic tumors of the abdomen and pelvis. The treatment is known to cause prolonged ileus and pseudo-obstruction. Risk factors of small bowel dysmotility after HIPEC and CRS are not well known.

Methods: A retrospective review of an IRB-approved database was conducted. We evaluated all patients who had HIPEC and CRS for metastatic colon and appendiceal cancer and mesothelioma from 2016-2023. We sub classified patients with a high or low peritoneal tumor burden by a validated peritoneal cancer index (PCI). Ileus and PSBO were diagnosed by abdominal imaging. NGT removal post op., use of TPN, enteral tubes, prokinetics and opioids was analyzed. Comparisons of categorical and continuous covariables were conducted using Fisher’s exact test and the Wilcoxon rank sum test, respectively. Predictors with p-values < 0.1 and sufficient data points were further analyzed by univariate and multivariate logistic regression analysis.

Results: 195 patients met the study criteria. PCI was available for 158 patients. There was no significant difference in the demographics of the low PCI (range 1-14, n: 54) and high PCI (range 15-29, n: 96) groups. There was a significantly higher bowel recovery time in the high PCI than low PCI group (median : 11.5 days vs 9 days), p = 0.027. Patients with persistent bowel dysfunction at day 30 were 7.47 times more likely to have malnutrition p = 0.001. TPN use at day 30 was associated with malnutrition (OR =3.58, 95%CI (1.27, 10.12), p = 0.016). TPN use was 2.63 times more likely in patients with bowel dysfunction at 30-day, p = 0.024). Persistent bowel dysfunction was 6.95 times more likely linked to a venting G tube p = 0.032). TPN users were 11.51 times more likely to have a venting G tube (OR =11.51, 95%CI (1.1, 120.69), p = 0.042). A h/o radiation therapy was 12.25 times more likely with bowel dysfunction complications (OR =12.25, 95%CI (1.5, 99.83), p = 0.019). The use of mu receptor antagonist was only seen in 2 patients.

Discussion:



  1. This study identified statistically significant risk factors for prolonged post op bowel dysfunction after HIPEC and CRS. A high PCI score, malnutrition and use of TPN for 30 days, a history of pelvic radiation therapy were statistically significant risk factors. The use of peripherally acting mu receptor antagonists was rare.






Table: 1 Predictive factors for five outcome variables assessed by univariate and multivariate logistic regression analysis 
 
 Univariate Analysis  Multivariate Analysis  
PredictorsOR95% CIP-valueOR95% CIP-value
                                                                                                                             Post-Op Bowel functioning (30 days)
Persistent SBO3.49(1.33,9.14)0.011 2.95 (1.02,8.52) 0.046
TPN3.38(1.53,7.46)0.003 2.63 (1.14,6.07) 0.024
TPN Duration (days)1.00(0.99,1.01)0.508   
                                                                                                                                                 Malnutrition
Opioid use History2.93(1.31,6.52)0.009 2.00 (0.78,5.13) 0.148
Abnormal CT scan at Dx2.62(1.15,5.96)0.022 1.87 (0.68,5.14) 0.228
Persistent SBO7.74(2.85,21.00)< .0001 7.47 (2.24,24.89) 0.001
NPO Duration (days)1.13(1.03,1.23) 0.011 1.02 (0.92,1.13) 0.700
TPN6.20(2.67,14.36) < .0001 3.58 (1.27,10.12) 0.016
TPN Duration (days)1.01(0.99,1.03) 0.238   
                                                                                                                                             Bowel dysfunction
BMI0.89(0.79,1.01) 0.066 0.83 (0.72,0.97) 0.019
Opioid use History4.14(1.07,16.02) 0.039 2.99 (0.6,14.86) 0.180
Radiation Abd Pelvis6.94(1.49,32.46) 0.014 12.25 (1.5,99.83) 0.019
Abnormal CT scan at Dx4.71(1.40,15.93) 0.013 3.67 (0.81,16.52) 0.091
NPO Duration (days)1.11(1.01,1.22) 0.025 1.03 (0.91,1.17) 0.623
TPN11.13(2.33,53.12) 0.003 9.70 (1.46,64.52) 0.019
TPN Duration (days)1.00(1.00,1.01) 0.309   
Feeding Tube Duration (days)1.02(0.95,1.09) 0.585   
                                                                                                                                               Venting G Tube
Persistent SBO16.83(3.36,84.40) 0.001 6.95 (1.19,40.64) 0.032
NPO Duration (days)1.12(1.01,1.23) 0.033 1.01 (0.88,1.15) 0.930
TPN19.75(2.33,167.73) 0.006 11.51 (1.1,120.69) 0.042
 Note: SBO: Small Bowel Obstruction, NPO means "nothing by mouth", TPN: Total Parental Nutrition.


Disclosures:
Sidra Naz indicated no relevant financial relationships.
Ahmed Sayed Ahmed indicated no relevant financial relationships.
Jianliang Dai indicated no relevant financial relationships.
Irene Lee indicated no relevant financial relationships.
Beth Helmink indicated no relevant financial relationships.
Mehnaz Shafi indicated no relevant financial relationships.


Sidra Naz, MD, MPH1, Ahmed Sayed Ahmed, MBBCh2, Jianliang Dai, 3, Irene Lee, MD4, Beth Helmink, MD, PhD3, Mehnaz A. Shafi, MD3. P2628 - Risk Factors of Prolonged Bowel Dysfunction After Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery for the Treatment of Metastatic Tumors of the Abdomen and Pelvis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.