Research and Awareness

Surgical Oncology Research

Dr. Andrei Nikiforchin, Dr. Ekaterina Baron, Dr. Carlos Munoz at the Advanced Cancer Therapies conference in Orlando Florida in February

The comprehensive HIPEC program at Mercy is a highly specialized referral center, reaching patients throughout the United States with over 900 HIPEC procedures performed. Our clinical team consists of surgical oncologists, medical oncologists, physician assistants, nurses, and other specialists working together to provide the best possible treatment and care for our patients.

Dr. Armando Sardi and colleagues, Dr. Vadim Gushchin and Dr. Kurtis Campbell, are widely recognized for their HIPEC expertise and lead the research department of surgical oncology. The research team consists of a study coordinator, a research nurse coordinator, research scholars, and a research advisor. The team manages the clinical trials and research studies, performs medical literature reviews, and conducts data collection and analysis with the intent to publish in major medical journals and present at medical symposia. 

The research scholar program aims to train future researchers to better expand the knowledge available to both the scientific and the medical communities, leading to better cancer care and management. 

Our objective is to educate general practitioners, general surgeons, and surgical and medical oncologists on HIPEC treatment for advanced cancers with peritoneal spread. We are able to increase HIPEC awareness in the medical community through our:

• Clinical research trials/studies
• Data presentation at national and international conferences
• Publication of our work in major medical journals with 15 publications in 2020

This work will ultimately lead to timely referrals and the appropriate care with improved patient outcomes. Through our research efforts, we aim to increase HIPEC education and awareness as a life-saving treatment option in cancers with peritoneal spread.

2022 Accomplishments

• Advanced Cancer Therapies (ACT), International Conference on Surgical Cancer Care Annual Meeting [Dallas, TX]
• Controlling Perfusion Temperature Relates to Better Outcomes After CRS/HIPEC
• Mini-Oral Presentation
• Society of Surgical Oncology (SSO), International Conference on Surgical Cancer Care Annual Meeting [Dallas, TX]
• Defining ‘High’ PCI as a Prognostic Factor in Appendiceal Cancer Patients Treated with CRS/HIPEC
• Recipient of the 2022 SSO/ACPMP Travel Award
• Published in Annals of Surgical Oncology
• Association of Preoperative C-Reactive Protein with Survival in Different Histologies of Mucinous Appendiceal Cancer
• Recipient of the 2022 SSO/ACPMP Travel Award
• Published in Annals of Surgical Oncology
• Value of Diagnostic Laparoscopy in Appendiceal Cancer Patient Selection for CRS/HIPEC
• Recipient of the 2022 SSO/ACPMP Travel Award
• Published in Annals of Surgical Oncology
• A Proposed ABCD Classification for Reporting Complications after Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
• Published in Annals of Surgical Oncology
• Safety of Nephrectomy Performed During CRS/HIPEC: A Propensity Score Matched Study
• Published in Annals of Surgical Oncology
• Controlling Perfusion Temperature Relates to Better Outcomes After CRS/HIPEC
• Published in Annals of Surgical Oncology
• American College of Surgeons, Maryland Chapter, Annual Spring Meeting [Virtual]
• Impact of Clinical Factors on Survival Outcomes after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Mucinous Appendiceal Cancer
• Oral Presentation
• The Value of Surgical Collaboration during Cytoreductive Surgery for Advanced Ovarian Cancer
• Oral Presentation
• International Gynecologic Cancer Society (IGCS), Annual Global Meeting [New York, NY]
• Peritoneal Carcinomatosis from Rare Ovarian Tumors Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
• Abstract published in the International Journal Gynecological Cancer
• Patterns of Recurrence after Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer Patients with Neoadjuvant Chemotherapy or Upfront Surgery
• Abstract published in the International Journal of Gynecological Cancer
• International Society for the Study of the Pleura and Peritoneum (ISSPP), 3rd Annual Congress [Huntington Beach, CA]
• Early Postoperative Hematologic Toxicity after Hyperthermic Intraperitoneal Chemotherapy
• Abstract published in Pleura and Peritoneum
• C-reactive Protein Albumin Ratio as a Predictor of Major Morbidity after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) in Ovarian Cancer
• Abstract published in Pleura and Peritoneum
• Achieving Intraperitoneal Disease Control using Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Two Cases of Metastatic Breast Cancer
• Abstract published in Pleura and Peritoneum

10 publications in top-tier medical journals, topics include:

• Annals of Surgical Oncology
• Iterative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Mucinous Adenocarcinoma of the Appendix
• **Mercy is one of the few high volume centers with unparalleled experience in repeated CRS/HIPEC procedures, which this in-depth analysis shows can lead to longer survival in patients with recurrent appendix cancer.
• ASO Author Reflections: If at First You Don’t Succeed, Try, Try Again: Iterative CRS/HIPEC for Recurrent Mucinous Appendix Cancer
• **Because of the impact of the above publication, the Annals of Surgical Oncology invited us to write a commentary on the clinical significance of our results – repeated HIPEC should be considered and performed at a high-volume center for patients with recurrent appendix cancer.
• Systemic Chemotherapy in High-grade Mucinous Appendiceal Cancer with Peritoneal Spread after Unsuccessful CRS/HIPEC
• **There is currently no data regarding how to treat patients with appendix cancer when CRS/HIPEC is not an option. This study provides the strongest evidence in the world showing that there is a survival benefit of systemic chemotherapy in select patients with appendix cancer after failed or incomplete CRS/HIPEC.
• ASO Author Reflections: CRS/HIPEC Can’t be Done. Now What? Systemic Chemotherapy in Mucinous Appendiceal Cancer
• **The Annals of Surgical Oncology invited us to write an article discussing the impact of our study that provides the only data available regarding systemic chemotherapy in unresectable appendix cancer patients.
• Safety of Nephrectomy Performed during CRS/HIPEC: A Propensity Score Matched Study
• **Many patients are denied an opportunity for long-term survival with CRS/HIPEC when the kidney is involved with tumor; however, Mercy’s extensive surgical expertise demonstrates that nephrectomy can be performed safely during CRS/HIPEC.
• ASO Author Reflections: Should I Stay or Should I Go? Nephrectomy for Complete CRS/HIPEC
• **Invited by the Annals of Surgical Oncology, we reflect on the impact this data will have to allow experienced surgeons to consider CRS/HIPEC at high-volume centers, like Mercy, for patients who may otherwise be denied an opportunity for long-term survival.
• Current Oncology
• The Role of Microorganisms in Appendiceal Pseudomyxoma Peritonei: A Review
• **Given Mercy’s unique experience investigating the biologic role of microorganisms in PMP disease development, Mercy was invited by the Current Oncology to write this review article for a special issue as one of the few centers performing translational research in this rare disease.
• Lancet Oncology
• Oncology Specialists’ Perspective on Caring for Patients with Cancer during the Early Days of War in Kyiv, Ukraine
• **This timely publication was one of the first to discuss the challenges faced by oncologists and the steps needed to ensure adequate cancer care during large-scale military conflict.
• European Journal of Surgical Oncology
• Adjuvant Chemotherapy for High-Grade Appendiceal Cancer after Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
• **Currently, patients are offered chemotherapy based on data on colon cancer. However, in this one-of-a-kind study with only appendix cancer patients, Mercy found that colon-type systemic chemotherapy after CRS/HIPEC does not provide any survival benefit in appendix cancer patients. As the strongest available evidence to date, this important research will prevent patients from receiving unnecessary chemotherapy.
• Global Medical Knowledge Alliance (online book chapter)
• Surgical Management of Peritoneal Metastases from Colorectal Cancer
• **Invited by leading oncologists at Harvard for our renowned and extensive experience in CRS/HIPEC and gastrointestinal cancers, we wrote a book chapter summarizing recommendations and guidelines for performing CRS/HIPEC in colorectal cancer, which has been published in multiple languages and serves as a main resource for oncologists in developing countries.

Active recruitment for 2 clinical trials

• HOT Trial: HIPEC in Ovarian cancer as initial Treatment, Clinical Trials ID: NCT02124421
• Appendiceal Microbiome Study, in collaboration with the American Gut Project

Extensive data collection and tracking with 7 observational studies

• Surgical Oncology Research Database and Tissue Resource
• Microbiologic and Immune Characteristics of Peritoneal Tissues in Patients with Appendiceal Cancer with Peritoneal Spread
• A Study of Tissue Molecular Markers and their Relationship to Treatment and Outcome in Appendiceal Cancer with Pseudomyxoma Peritonei (PMP)
• Use of Hyperthermic Intraoperative Chemotherapy at the Time of Interval Cytoreductive Surgery in Patients Managed with Neo-adjuvant Chemotherapy for Mullerian Cancers
• Clinical Outcomes and Feasibility of Hyperthermic Intraperitoneal Chemotherapy in Treatment of Uterine Leiomyosarcoma
• Next-generation Sequencing (NGS) and Analysis of Mutations in a Cohort of Patients with Peritoneal Carcinomatosis who Underwent Cytoreductive Surgery and/or Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC)
• Identification of Genomic Alterations in Diffuse Malignant Peritoneal Mesothelioma

Continued unique research collaboration with multiple institutions:

• Multi-Institutional International Peritoneal Surface Oncology Group (HIPEC)
• Gynecologic Oncology at Mercy Medical Center (Ovarian & Uterine Cancers)
• Pathology at Mercy Medical Center (PMP & Rare Tumors)
• Uniformed Services University (PMP)
• University of South Carolina (PMP)
• University of California, San Diego (PMP)
• Colorado State University (PMP)
• INOVA Fairfax Hospital (Colon Cancer, Ovarian Cancer, and Mesothelioma)
• University of Pittsburgh Medical Center (PMP, HIPEC)

Establishing partnerships with outside organizations to analyze molecular profiles of exceptional and poor responders in appendiceal and ovarian cancers

• Tempus Labs, Inc.
• Caris Life Sciences

Expansion of the research department team, including