eP543 - Higher Post-Operative Morbidity Among Colorectal Cancer Patients Undergoing HIPEC with KRAS Mutations

ePoster Presenter(s)

• 

  Alexandra E. Hernandez, MD, MPH (she/her/hers)

  Postdoctoral Scholar
  University of Miami/Jackson Health System
  University of Miami / Jackson Health System
  Miami, FL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• CC

  Charles Cash, BS

  Medical Student
  University of Miami Miller School of Medicine
  Miami, Florida, United States

  Disclosure information not submitted.
• MM

  Mariaugusta Montealegre, MD

  Research Fellow
  University of Miami
  Miami, Florida, United States

  Disclosure information not submitted.
• KG

  Kimberly Gomez, MD

  Research Fellow
  University of Miami
  Miami, Florida, United States

  Disclosure information not submitted.
• SY

  Sina Yargaradenia, MD

  General Surgery Resident
  University of Miami/JFK Hospital
  Miami, Florida, United States

  Disclosure information not submitted.
• PJ

  Priyashma Joshi, BS

  Medical Student
  University of Miami Miller School of Medicine
  Miami, Florida, United States

  Disclosure information not submitted.
• LF

  Luanne Force, Md

  Assistant professor of surgery
  University Of Miami
  Miami, Florida, United States

  Disclosure information not submitted.
• VH

  Vanessa W. Hui, MD

  Assistant Professor of Clinical Surgery
  University of Miami
  SOUTH MIAMI, Florida, United States

  Disclosure information not submitted.
• FM

  Floriano Marchetti, MD

  Professor
  University of Miami/Jackson Health System
  Miami, Florida, United States

  Disclosure information not submitted.
• NE

  Nkiruka Ezenwajiaku, MD

  Staff Physician
  University of Miami Health System
  Miami, Florida, United States

  Disclosure information not submitted.
• CR

  Chad Ritch, MD

  Associate Professor
  University of Miami Health System
  Miami, Florida, United States

  Disclosure information not submitted.
• AP

  Agustin Pimentel, MD

  Assistant Professor
  University of Miami Health System
  Miami, Florida, United States

  Disclosure information not submitted.
• HB

  Heidi Bahna, MD, FACS, FASCRS (she/her/hers)

  Program Director, General Surgery Residency, University of Miami/ JFK Medical Center
  Affiliate Associate Professor of Surgery, University of Miami
  University of Miami
  Lantana, Florida, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• MM

  Mecker Moller, MD

  Professor
  University of Miami Health System
  Miami, Florida, United States

  Disclosure information not submitted.

Purpose/Background: Colorectal cancer (CRC) is a molecularly heterogeneous disease with KRAS mutations generally associated with more advanced disease and a worse prognosis. Although still controversial, the role of cytoreductive surgery (CRS) with the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced-stage CRC is a treatment option for advanced CRC. Few studies have described the patient and post-operative morbidity differences among mutKRAS and wild-type patients undergoing CRS/HIPEC for advanced CRC.Methods/Interventions: Using a prospective cohort of 276 patients undergoing CRS/HIPEC, we identified 92 patients with CRC. Patients were categorized based on the presence (mutKRAS) or absence (wild-type) of KRAS mutations. Patient characteristics, tumor factors, treatment, and post-operative outcomes were compared between groups using standard statistical tests. Post-operative complications were characterized by Clavian-Dindo classification scores.Results/Outcomes: Of the 92 patients, 45 (48.9%) were identified with a KRAS mutation. Median age for wild-type was 52 (44-62) years and 50 (43-61) years for mutKRAS. The distribution of sex, race, and ethnicity was similar between groups. Interestingly, while stage, tumor grade, and symptoms at presentation were not significantly different amongst groups, the wild-type group had higher rates of metastasis than mutKRAS (83.0% vs 64.4%, respectively). While not statistically significant, median PCI at exploration for mutKRAS patients, 13 (5-24), was higher than wild-type [8 (5-15), p=0.05] and PCI post-surgery was significantly different [mutKRAS 0 (0-2) vs. wild-type 0 (0-0), p=0.005]. The mutKRAS group had less patients achieve an R0 resection (mutKRAS 55.6% vs wild-type 66.0%, p=0.027). Additionally, even though pre-operative Eastern Cooperative Oncology Group (ECOG)/WHO system scores were not significantly different, mutKRAS patients had higher rates of post-operative complications, with a higher proportion of mutKRAS patients having a Class 3 (complication that requires intervention) or higher (mutKRAS 28.9% vs. wild-type 6.4%, p=0.003). Length of stay (LOS) in the hospital and surgical ICU were not significantly different amongst groups.Conclusion/

Discussion: In this study of patients with colorectal cancer undergoing HIPEC, patients with KRAS mutations had higher rates of post-operative complications and lesser rates of an R0 resection, even though the wild-type group presented at a similar stage, had higher rates of metastasis, and similar hospital and ICU LOS. This unanticipated finding warrants further inquiry into why mutKRAS patients have higher post-operative morbidity.Table 1. Tumor, Pre-operative, Operative, and Post-operative Factors Among KRAS Mutation and Wild-Type Groups.