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

Abstract

This study was designed to identify factors associated with morbidity and mortality in patients older than 70years who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC). 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. 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 70years 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. Of 2328 patients, 188 patients older than aged 70years were matched with 704 younger patients. Patients older than aged 70years 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 70years 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. CRS and HIPEC appear feasible for selected patients older than aged 70years, albeit with a higher risk of medical complications associated with increased mortality.