P0830 - In Hot Water: Neurogastroenterology and Motility Sequelae of Cytoreductive Surgery (CRS) Plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Ellen C. Tan, DO¹, Dayyan-Ur-Rahman Syed, ², Saad Javed, MD¹
1Allegheny Health Network, Pittsburgh, PA; 2University of Pittsburgh, Pittsburgh, PA

Introduction: Radical surgery with regional chemotherapy has proven survival benefits in the management of peritoneal carcinomatosis from colorectal, appendiceal, gastric and ovarian cancers. We present a case series of neurogastroenterology and motility sequelae in 3 patients with abdominal cancers and peritoneal metastasis who were treated with cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC).

Case Description/

Methods: 58-year-old female with high grade appendiceal cancer underwent right hemicolectomy, peritonectomy, omentectomy + HIPEC (Mitomycin-C). Over months, she developed intense, episodic, abdominal cramping/distention, nausea and vomiting. CT scan showed dilated small bowel loops without obstruction. Small bowel follow-through showed barium transit time > 6 hours. Gastric emptying scan and sitz marker study were normal. A diagnosis of chronic intestinal pseudo-obstruction (CIPO) was made and she was successfully treated with prucalopride and pyridostigmine.

47-year-old female with stage IVB serous ovarian cancer underwent hysterectomy, bilateral salpingo-oophorectomy, peritonectomy, omentectomy and right hemicolectomy followed by adjuvant chemotherapy. PET/CT scan showed recurrent peritoneal metastases requiring secondary cytoreduction + HIPEC (cisplatin/paclitaxel). 6 months later, she had diarrhea, steatorrhea, unintentional weight loss, alopecia and vitamin D deficiency. She was diagnosed with exocrine pancreatic insufficiency with a fecal elastase level of 38. Symptoms improved remarkably on pancreatic enzyme replacement therapy.

76-year-old male with stage IV sigmoid colon cancer underwent systemic chemotherapy with substantial decrease in peritoneal disease followed by CRS (anterior resection of the rectum, sigmoid resection, peritonectomy and omentectomy) + HIPEC (oxaliplatin). 1-year follow-up revealed no signs of local recurrence or distal metastases. Post CRS + HIPEC, he developed ongoing postprandial nausea, emesis and bloating. A gastric emptying scan confirmed the diagnosis of gastroparesis and he was managed with metoclopramide and anti-emetics.


Discussion: CRS + HIPEC has altered the treatment landscape of abdominal cancers with peritoneal metastasis. Understanding complications of this synergistic approach is essential for enhancing patient outcomes and surgical oncology techniques. Despite the risks, careful patient selection and expertise of specialized institutions can lead to acceptable morbidity and management of post-interventional GI sequelae.

Disclosures:
Ellen Tan indicated no relevant financial relationships.
Dayyan-Ur-Rahman Syed indicated no relevant financial relationships.
Saad Javed indicated no relevant financial relationships.

Ellen C. Tan, DO¹, Dayyan-Ur-Rahman Syed, ², Saad Javed, MD¹. P0830 - In Hot Water: Neurogastroenterology and Motility Sequelae of Cytoreductive Surgery (CRS) Plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.