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Multicenter Study
. 2016 Dec;23(Suppl 5):737-745.
doi: 10.1245/s10434-016-5519-2. Epub 2016 Sep 6.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study

Mohammad Alyami  1   2 , Peter Lundberg  1 , Vahan Kepenekian  1 , Diane Goéré  3 , Jean-Marc Bereder  4 , Simon Msika  5 , Gérard Lorimier  6 , François Quenet  7 , Gwenaël Ferron  8 , Emilie Thibaudeau  9 , Karine Abboud  10 , Réa Lo Dico  11 , Delphine Delroeux  12 , Cécile Brigand  13 , Catherine Arvieux  14 , Frédéric Marchal  15 , Jean-Jacques Tuech  16 , Jean-Marc Guilloit  17 , Frédéric Guyon  18 , Patrice Peyrat  19 , Denis Pezet  20 , Pablo Ortega-Deballon  21 , Franck Zinzindohoue  22 , Cécile de Chaisemartin  23 , Reza Kianmanesh  24 , Olivier Glehen  1   25 , Guillaume Passot  26   27   28 ; BIG-RENAPE and RENAPE Working Groups
Collaborators, Affiliations
Multicenter Study

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study

Mohammad Alyami et al. Ann Surg Oncol. 2016 Dec.

Abstract

Objective: This study was designed to identify factors associated with morbidity and mortality in patients older than 70 years who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC).

Background: Major surgery is associated with higher morbidity and mortality in elderly patients. For PC, CRS and HIPEC is the only current potential curative therapy, but the risks inherent to this patient population have called its benefits into question.

Methods: We retrospectively analyzed a multi-center database from 1989 to 2015. All patients who underwent CRS and HIPEC for PC were selected and patients older than 70 years were matched 1:4 with a younger cohort according to cancer origin, peritoneal cancer index (PCI), and completeness of cytoreduction. Major morbidity and mortality were analyzed.

Results: Of 2328 patients, 188 patients older than aged 70 years were matched with 704 younger patients. Patients older than aged 70 years demonstrated a higher American Society of Anesthesiologist score (≥ASA III 10.8 vs. 6.6 %, p = 0.008). There was no difference in overall 90-day morbidity (≥70: 45.7 % vs. <70: 44.5 %; p = 0.171); however, patients older than 70 years had significantly more cardiovascular complications (13.8 vs. 9.2 %, p = 0.044). Differences between the older and younger cohorts failed to reach significance for 90-day mortality (5.4 and 2.7 %, respectively; p = 0.052), and failure-to-rescue (11.6 and 6.1 %, respectively; p = 0.078). In multivariate analysis, PCI > 7 (95 % CI 1.051-5.798, p = 0.038) and HIPEC duration (95 % CI 1.106-6.235, p = 0.028) were independent factors associated with morbidity in elderly patients.

Conclusions: CRS and HIPEC appear feasible for selected patients older than aged 70 years, albeit with a higher risk of medical complications associated with increased mortality.

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