Outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with or without intraoperative radiotherapy for peritoneal carcinomatosis in elderly patients

Abstract

BackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may alter the prognosis of peritoneal carcinomatosis (PC), offering the possibility of long-term survival. We report short- and long-term outcomes among older patients with PC treated with CRS–HIPEC. MethodsWe retrospectively reviewed data from 37 patients aged ≥65 years who underwent CRS–HIPEC with or without intraoperative radiotherapy (IORT) for PC from 2010 to 2016. Residual tumors were assessed using completeness of cytoreduction (CC) scores. Adverse events were categorized by Clavien-Dindo (CD) scores. Cox regression analysis was used to identify potential prognostic factors for mortality. ResultsMedian patient age was 71.1 (65–85) years, and nine patients were ≥75 years. Most primary were intestinal (13), gastric (10), or gynecologic (9). The mean of Peritoneal Carcinomatosis Index (PCI) score was 9.8 (rang 1–35), CC scores were 0 in 25 patients and 2–3 in 4 patients, and CD score was 0 in 62.2% and ≥2 in 32.4%. Seventeen patients received IORT. The Median follow-up was 31 months. Mortality was 5.4% at 90 days postoperatively. Estimated 5- and 7-years overall survival rates were 40% and 25%. Age ≥75 years (hazard ratio [HR] 4.15) and CD score ≥2 (HR 12.8) were identified as significant risk factors for mortality. IORT was not associated with postoperative mortality, HR 2.4 (0.6–10.1), p 0.23. Conclusions90-day mortality and long-term overall survival after CRS–HIPEC for PC in an elderly Saudi population are comparable to outcomes from other countries. Age ≥75 and CD score ≥2 were significant prognostic factors for risk of death.