Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases in an elderly population: outcomes from a single centre

Abstract

Background: The prevalence of elderly patients with resectable colorectal peritoneal metastases (CRPM) is increasing. This study aimed to compare short and long-term outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRPM in patients above and below 70 years of age. Methods: This was a retrospective, 10-year analysis of 90-day major morbidity and mortality, and long-term survival. Results: Thirty-two (21.3%) of 150 consecutive patients who underwent CRS and HIPEC during the study period were aged 70 and older. PCI (P = 0.04), perioperative chemotherapy use (P < 0.01) and organ resections (rectum P = 0.04, diaphragm P = 0.03) were less in the over 70 group. There was no significant differences in major morbidity (P = 0.19) and mortality (P = 0.32). There was also no difference in 5-year overall survival (OS) (≥70: 26% vs. <70: 39%; P = 0.68) and disease-free survival (DFS) (≥70: 25% vs. <70: 14%; P = 0.22). Age above 70 was not independently associated with worse OS (HR 1.55, P = 0.20) and DFS (HR 1.07, P = 0.81). Conclusion:The surgical management of CRPM appears safe and feasible in this elderly population. Appropriate selection of elderly patients for such radical intervention is reinforced by the comparable survival with those under 70.

A call for standardized reporting of early-onset colorectal peritoneal metastases

“…PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Sharma et al, 2021;Tabchouri et al, 2021;Yang et al, 2021;Zhou et al, 2021;Flood et al, 2022;Iwasaki et al, 2022;McCleary et al, 2022;Meyer et al, 2022;Nagao et al, 2022).…”

“…Forty-nine papers were excluded from the review for age-related reasons: six studies had 0–3 patients under age 50. Forty-three studies included patients under age 50 but did not present results stratified by age or did not stratify using an age ≤50 years old for stratification; one study provided above/below-age data but failed to include symbols (≥ or ≤) or descriptive text to indicate which group included the cutoff age (Sternberg et al , 1994; Nakae et al , 1995; Nakamura et al , 1999; Akasu et al , 2000; el-Ghazawy et al , 2001; Luna-Pérez et al , 2002; Al-Shamsi et al , 2003; Kanemitsu et al , 2003; Carmignani et al , 2004; Lloyd et al , 2006; Nervi et al , 2006; Lawson et al , 2008; Sobhani et al , 2008; Song et al , 2009; Aghili et al , 2010; Lemmens et al , 2011; Sjo et al , 2011; Lieu et al ., 2014; Park et al , 2014; Saluja et al , 2014; Adachi et al , 2015; Lam et al , 2015; Sica et al , 2015; Simkens et al , 2015; 2016; Maillet et al , 2016; Wang et al , 2016; Cicero et al , 2017; Hojo et al , 2017; Patil et al , 2017; Cigdem Arslan et al , 2018; Kondo et al , 2021; Melli et al , 2021; Rieser et al , 2021a, 2021b; Sharma et al , 2021; Tabchouri et al , 2021; Yang et al , 2021; Zhou et al , 2021; Flood et al , 2022; Iwasaki et al , 2022; McCleary et al , 2022; Meyer et al , 2022; Nagao et al , 2022).…”

Perioperative outcomes of cytoreductive surgery for tumours of colorectal or appendiceal origin with ovarian involvement

“…Bakkers et al showed that younger age (<50 years old) was associated with an increased risk of OM, while increasing age in patients with OM, especially >70 years old, was associated with a poorer prognosis, however, they did not comment on morbidity 1 . A more recent study has shown no difference in major morbidity and mortality between patients >70 years old and those <70 years old, thus age alone should not deter clinicians from offering CRS ± HIPEC to appropriately selected patients 15 . Preoperative optimisation remains important for all prospective patients, given high overall morbidity.…”

“…1 A more recent study has shown no difference in major morbidity and mortality between patients >70 years old and those <70 years old, thus age alone should not deter clinicians from offering CRS ± HIPEC to appropriately selected patients. 15 Preoperative optimisation remains important for all prospective patients, given high overall morbidity.…”