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Background Surgical high dependency (SHD) allows for intermediate care provision between general ward (GW) and intensive care unit (ICU) for surgical patients but no universally accepted admission criteria exists. Unnecessary SHD admissions should be minimized to limit resource wastage and maintain spare critical care capacity. This study evaluates the utility of SHD admissions following elective laparoscopic colectomy by comparing post-operative outcomes and interventions performed between SHD and GW patients. Methodology A retrospective review of all colorectal cancer patients who underwent elective laparoscopic colectomy in our institution between January 2019 and December 2021 was conducted. Patients converted to open surgery or admitted to IC post-operatively were excluded. Peri-operative parameters and outcomes between patients admitted to GW and SHD post-operatively were evaluated. Results The cohort comprised 393 patients. There were 153 patients (38.93%) who required SHD admission. SHD patients had higher American Society of Anesthesiology (ASA) scores, body mass index, age and intra-operative blood loss. Majority of post-operative morbidity were minor (Clavien–Dindo II or lower) in both groups and the interventions required were safely instituted in both SHD and GW. None of the patients in the cohort required inotropic or ventilatory support in the SHD. Conclusions GW patients were “healthier” but post-operative morbidity and interventions required were similar to the SHD group. Nonetheless, treatment delays, absence of continuous monitoring, and decreased nurse-to-patient ratio may be significant for patients with limited physiological reserves. Further studies should evaluate safety and cost-effectiveness of managing high risk surgical patients in GW using continuous remote vital signs monitoring.

360 Background: PIPAC is a novel, laparoscopic intraperitoneal chemotherapy delivery technique which aims to improve on hyperthermic intraperitoneal chemotherapy (HIPEC), ameliorating drug distribution and tissue penetration. Thus far, PIPAC has been conducted with oxaliplatin chemotherapy in Europe, at an arbitrary dose of 92mg/m2; 150mg/m2 was found to be intolerable. We conducted a dose-escalation phase 1 study to establish the safety, tolerability and recommended phase 2 dose (RP2D) for PIPAC in Asian patients. Methods: This phase 1 study of oxaliplatin administered via PIPAC was designed as a traditional 3+3 dose escalation study for patients with predominant peritoneal metastasis from a gastrointestinal primary tumor, after failure of standard therapies. Dose levels were planned at 45, 60, 90 and 120mg/m2. Repeat doses of PIPAC were permitted, 6 weeks apart. Dose limiting toxicities (DLT) were defined as any clinically relevant grade 3 adverse events occurring within 28 days after PIPAC. Results: This study included 16 patients (25 PIPAC procedures; 8 gastric, 4 colorectal and 1 gallbladder, pancreas and appendix cancer each). Median age was 62 years, with a median peritoneal carcinomatosis index (PCI) score of 17 (range 1 - 39). Two patients developed pancreatitis (grade 2 and 3) on day 6 and day 9 after PIPAC administration at the dose cohort of 45mg/m2, necessitating cohort expansion to 6 patients. One patient was noted to have asymptomatic grade 3 hyperamylasemia (90mg/m2 cohort). There were no other DLTs and all 3 patients in the highest dose cohort (120mg/m2) tolerated PIPAC well. Nine patients who underwent a 2nd PIPAC procedure had a decrease in PCI score from 18.4 to 15.5; one patient at 120mg/m2 had an improvement in PCI from 30 to 12. Conclusions: The RP2D of PIPAC with oxaliplatin is 120mg/m2. Single agent PIPAC is well tolerated, and future studies with PIPAC must consider a bi-directional approach with the incorporation of systemic therapy, with either chemotherapy or immunotherapy to improve efficacy. Clinical trial information: NCT03172416.

6649 Background: The risk of recurrence for colorectal cancer (CRC) is low after 5 years (<1.5% per year) hence, surveillance visits, CEA blood tests and annual CT scans are not recommended beyond this period (NCCN guidelines). Importantly, right-siting survivorship care to the community allows primary care providers (PCP) to focus on preventive health beyond cancer. The National University Cancer Institute, Singapore, a tertiary, academic cancer center developed a program to transition CRC survivorship care to the community after 5-years of active surveillance. Patients (Pts) are discharged to the community with a survivorship care plan and followed-up via phone calls. We hypothesize that by transitioning CRC survivors to the community, we can optimize healthcare resources by reducing specialist visits and tests at the cancer center without compromising outcomes. Methods: From July 2018, CRC pts beyond 5-years from diagnosis with no evidence of cancer recurrence were eligible for transition. Pts were followed prospectively to determine date of cancer recurrence, issues preventing transition to the community and a phone survey on pt satisfaction was conducted for those who transitioned to primary care. Data on healthcare utilization amongst pts who transitioned vs. pts who remained in tertiary care was collected. Data cutoff was June 2022. Statistical analysis was performed with IBM SPSS Statistics (v28.0). Results: Between July 2018 - June 2022, there were 791 CRC pts who were eligible for transition, of which 534 pts (67.5%) had no clinical issues preventing transition and included in this analysis. 54.3% (N= 290) were males and stage distribution of cancers were 14.2%, 34.0%, 47.1% and 4.7% for stages I, II, III and IV, respectively. The mean number of years since diagnosis was 6.88 (range: 5-16 years; SD 2.25). 380 pts (71.2%) were transitioned to the community. There was consistently higher utilization of healthcare resources in the group not transitioned vs. transitioned: mean number of consults (2.86 vs 1.02; p<0.001); CEA (1.23 vs 0.31; p<0.001); CT scans (0.08 vs 0.05; p=0.221) and colonoscopies (0.25 vs 0.16; p=0.031). Mean healthcare expenditure (mean gross bill per year) was consistently higher in pts across all categories for the group not transitioned vs. transitioned: consults ($158 vs $56; p<0.001); CT scans ($60 vs $39; p=0.273); CEA ($26 vs $7; p<0.001) and colonoscopies ($208 vs $126; p=0.018). Importantly, recurrence rates were low with no difference in both groups (0.8% vs 1.3%; p=0.629). 82% of CRC pts were satisfied or very satisfied with follow-up care provided by their PCPs on a subsequent survey. Conclusions: We have demonstrated value-driven survivorship care by right-siting CRC survivors into the community. Healthcare resources were optimized with reduction in specialist visits and tests which lead to lower costs while recurrence rates remain low. Pt satisfaction in the community was also high.