Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis in the Elderly

Abstract

Background. The combined treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is a rigorous surgical treatment, most suitable for young and good performance status patients. We evaluated the outcomes of elderly patients undergoing CRS and HIPEC for peritoneal carcinomatosis with careful perioperative care. Methods. All consecutive patients 70 years of age or older who were treated for peritoneal carcinomatosis over the past five years were included. Primary outcomes were perioperative morbidity and mortality. Secondary outcomes were disease-free survival and overall survival. Results. From a pool of 100 patients, with a diagnosis of PC who underwent CRS and HIPEC in our center, we have included 30 patients at an age of 70 years or older and the results were compared to the patients younger than 70 years. The total morbidity rate was 50% versus 41.5% in the group younger than 70 years (NSS). The mortality rate was 3.3% in the elderly group versus 1.43% in the younger group (NSS). Median overall survival was 30 months in the older group versus 38 months in the younger group. Conclusion. Cytoreductive surgery and HIPEC for peritoneal carcinomatosis may be safely performed with acceptable morbidity in selected elderly patients.

Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis in the elderly

“…Mortality of the elderly patients in our study was 3 %, which was not statistically different from the mortality of the younger patients after undergoing CRS and PIC. Similar mortality and morbidity rates for performing CRS and PIC for elderly patients as compared to younger patients have also been reported previously [ 7 – 9 , 16 , 17 ]. Although the mortality of our patients in the subgroup (i.e.…”

“…A recent systematic review done by Chua et al has shown an optimal morbidity rate ranging from 12 to 52 % and a mortality rate ranging 0.9 and 5.8 % [ 6 ]. A considerable number of patients with peritoneal carcinomatosis are aged 60 or older and are more commonly associated with comorbidities due to their age [ 7 , 8 ]. Thus, whether the elderly can tolerate such an invasive surgery presents a challenge for healthcare professionals.…”

“…Thus, whether the elderly can tolerate such an invasive surgery presents a challenge for healthcare professionals. A few studies have previously investigated the relationship between age and the outcome of peritonectomy [ 7 – 9 ]. However, these studies were limited by their small sample size.…”

Serum lactate as predictor of morbidity, mortality and long term survival in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

“…Moreover, to account for potential confounders we used logistic regression. Specifically, in all cases we adjusted for potential effects of PCI and CCS based on prior knowledge [12] and independent of the estimated p-value; as for the rest of the confounders, we included them in the final model only if they had statistically significant results.…”

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of ovarian cancer

“…[18] The operations can be summarized as follows: [19] • Since cytoreductive surgery is a major abdominal operation, with possible morbidity, good preoperative patient selection is of crucial importance, so as to identify which patients will benefit more from such an extensive procedure. While so far age over than 65 years was considered a major contraindication for cytoreductive surgery and HIPEC, [20] two recent studies by Votanopoulos et al [21] and Spiliotis et al [22] demonstrated that HIPEC can be safely performed in patients older than 70 years, with acceptable postoperative morbidity and mortality.…”