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

Abstract

BackgroundPeritoneal carcinomatosis is life-threatening without cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC). Only a few studies in the literature addressed the relationship between age and outcomes of peritonectomy. This study was designed to review the clinical outcomes in elderly patients who underwent CRS and PIC.MethodsThis is a retrospective study of prospectively collected data of 611 consecutive patients with peritoneal carcinomatosis who underwent CRS and PIC by the same surgical team at St George Hospital in Sydney, Australia, between January 1996 and December 2013. Patients were divided into two groups; group 1 (<65 years old, n = 487) and group 2 (≥ 65 years old, n = 124). Subgroup analysis was performed in patients who were ≥75 years old (n = 20). A significant difference was defined as p < 0.05.ResultsThere was no significant statistical difference in terms of mean total hospital stay, intensive care unit stay, high dependency unit stay and complication rates. Postoperative mortality was 2 and 3 % in groups 1 and 2, respectively. Overall survival did not reach a statistical significance between the two groups. In subgroup analysis, patients showed similar morbidity results to patients who were <65 years old.ConclusionsCRS and PIC can be safely done in the elderly. Age alone should not be the single exclusion criterion but rather taken into consideration along with other factors to determine the suitability of elderly patients.

Overall survival and morbidity are not associated with advanced age for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience

“…Our results demonstrated no statistically significant difference in OS despite increased mortality in the older population. While this has similarly been reported in the literature ( Table 5 ), there are also several other studies which have demonstrated worse OS outcomes for older patients [ 29 ], [ 30 ], [ 31 ], [ 32 ], [ 33 ], [ 34 ], [ 35 ], [ 36 ], [ 37 ], [ 38 ]. However, many of these studies consisted of small sample sizes and were undertaken in small peritonectomy units, thus, results may be confounded by inexperience or low case volumes for operating on older patients.…”

Preoperative Management of Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

“…The postoperative mortality was 2 % and 3 % in the 2 groups respectively and there was no difference in the overall survival as well. [40] Three other retrospective studies with smaller number of patients have concluded the same. [41][42][43] The above evidence strongly suggests that age alone can not be a contraindication for the procedure.…”

Colonic adenocarcinoma encasing the femoral nerve: complete surgical excision with preservation of function

“…In patients with peritoneal cancer index less than six, 5‐year survival approached 50% in a large retrospective series . Further, an Australian study of 611 patients demonstrated that cytoreductive surgery can be successfully performed in the elderly with equally good results . Of note, femoral nerve injuries are not uncommonly reported after pelvic surgery in around 2% of cases .…”