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Survival outcomes in patients aged 75 years and over with peritoneal colorectal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): multicenter study of the Spanish Group of Peritoneal Cancer Surgery (GECOP)

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Abstract

Background

The attitude toward cytoreductive surgery with HIPEC in peritoneal carcinomatosis from colorectal cancer is unclear. The aim of this study is to report the perioperative outcomes after cytoreductive surgery with HIPEC in patients ≥ 75 years.

Methods

This retrospective multicenter study collected the data the Spanish Group of Peritoneal Cancer Surgery. Thirty-six patients with peritoneal carcinomatosis from colorectal cancer met the selection criteria for the study. Morbidity, mortality, disease-free and overall survival were analyzed.

Results

Morbidity (grade III–IV) was 17% and 2 patients died of complications related to the procedure (5.4%). Median disease-free survival (DFS) was 16 months. DFS at 1 and 3 years was 81% and 42%, respectively. Overall survival at 1 and 3 years was 96% and 75%. In the univariate analysis, preoperative comorbidities (p = 0.01), liver metastases (p = 0.02), blood transfusion (p = 0.001) and postoperative complications (p = 0.001); and in the multivariate analysis, perioperative blood transfusion (OR 2.56, 95% CI 1.95–6.24, p = 0.03) and postoperative complications (OR 3.25, 95% CI 2.35–7.56, p = 0.02) were associated with a lower overall survival.

Conclusions

Age is not an absolute contraindication to perform cytoreduction surgery with HIPEC in highly selected elderly patients with colorectal peritoneal carcinomatosis.

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References

  1. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21:3737–43.

    Article  Google Scholar 

  2. Verwaal VJ, Bruin S, Boot H, et al. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15:2426–32.

    Article  Google Scholar 

  3. Esquivel J, Lowy AM, Markman M, et al. The American Society of Peritoneal Surface Malignancies (ASPSM) Multiinstitution evaluation of the peritoneal surface disease severity score (PSDSS) in 1,013 patients with colorectal cancer with peritoneal carcinomatosis. Ann Surg Oncol. 2014;21:4195–201.

    Article  Google Scholar 

  4. Prada-Villaverde A, Esquivel J, Lowy AM, et al. The American Society of Peritoneal Surface Malignancies evaluation of HIPEC with Mitomycin C versus Oxaliplatin in 539 patients with colon cancer undergoing a complete cytoreductive surgery. J Surg Oncol. 2014;110:779–85.

    Article  CAS  Google Scholar 

  5. Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.

    Article  CAS  Google Scholar 

  6. de Bree E, Romanos J, Michalakis J, et al. Intraoperative hyperthermic intraperitoneal chemotherapy with docetaxel as second-line treatment for peritoneal carcinomatosis of gynaecological origin. Anticancer Res. 2003;23:3019–27.

    PubMed  Google Scholar 

  7. Spiliotis JD, Halkia E, Boumis VA, et al. Cytoreductive surgery and HIPEC for peritoneal carcinomatosis in the elderly. Int J Surg Oncol. 2014;2014:987475.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Macrì A, Saladino E, Trimarchi G, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in elderly patients. Vivo. 2011;25:687–90.

    Google Scholar 

  9. Klaver YL, Chua TC, de Hingh IH, et al. Outcomes of elderly patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for colorectal cancer peritoneal carcinomatosis. J Surg Oncol. 2012;105:113–8.

    Article  CAS  Google Scholar 

  10. Tabrizian P, Jibara G, Shrager B, et al. Outcomes for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the elderly. Surg Oncol. 2013;22:184–9.

    Article  Google Scholar 

  11. Votanopoulos KI, Newman NA, Russell G, et al. Outcomes of Cytoreductive Surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients older than 70 years; survival benefit at considerable morbidity and mortality. Ann Surg Oncol. 2013;20:3497–503.

    Article  Google Scholar 

  12. López-López V, Cascales-Campos PA, Schneider MA, Gil J, Gil E, Gomez-Hidalgo NR, Parrilla P. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in elderly patients. A systematic literature review. Surg Oncol. 2016;25:378–84.

    Article  Google Scholar 

  13. Quenet F, et al. A UNICANCER phase III trial of hyperthermic intra-peritoneal chemotherapy (HIPEC) for colorectal peritoneal carcinomatosis (PC): PRODIGE 7. J Clin Oncol. 2018;39:1.

    Google Scholar 

  14. Tournigand C, André T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22:229–37.

    Article  CAS  Google Scholar 

  15. van Cutsem E, Köhne C, Láng I, et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol. 2011;29:2011–9.

    Article  Google Scholar 

  16. Saltz LB, Clarke S, Díaz-Rubio E, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008;26:2013–9.

    Article  CAS  Google Scholar 

  17. Modest DP, Pant S, Sartore-Bianchi A. Treatment sequencing in metastatic colorectal cancer. Eur J Cancer. 2019;109:70–83.

    Article  CAS  Google Scholar 

  18. Heinemann V, von Weikersthal LF, Decker T, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomized, open-label, phase 3 trial. Lancet Oncol. 2014;15:1065–75.

    Article  CAS  Google Scholar 

  19. Deraco M, Casali P, Inglese MG, et al. Peritoneal mesothelioma treated by induction chemotherapy, cytoreductive surgery, and intraperitoneal hyperthermic perfusion. J Surg Oncol. 2003;83:147–53.

    Article  Google Scholar 

  20. Elias D, Delperro JR, Sideris L, et al. Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol. 2004;11:518–21.

    Article  Google Scholar 

  21. Mahteme H, Hansson J, Berglund A, et al. Improved survival in patients with peritoneal metastases from colorectal cancer: a preliminary study. Br J Cancer. 2004;90:403–7.

    Article  CAS  Google Scholar 

  22. Yan TD, Black D, Savady R, Sugarbaker PH. Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol. 2006;24:4011–9.

    Article  Google Scholar 

  23. Bae JH, Lee JM, Ryu KS, et al. Treatment of ovarian cancer with paclitaxel-or carboplatin-based intraperitoneal hyperthermic chemotherapy during secondary surgery. Gynecol Oncol. 2007;106:193–200.

    Article  CAS  Google Scholar 

  24. Pavlov MJ, Kovacevic PA, Ceranic MS, et al. Cytoreductive surgery and modified heated intraoperative intraperitoneal chemotherapy (HIPEC) for advanced and recurrent ovarian cancer—12-year single center experience. Eur J Surg Oncol. 2009;35:1186–91.

    Article  CAS  Google Scholar 

  25. Chua TC, Saxena A, Schellekens JF, et al. Morbidity and mortality outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy at a single tertiary institution: towards a new perspective of this treatment. Ann Surg. 2010;251:101–6.

    Article  Google Scholar 

  26. Cascales-Campos PA, López-López V, Muñoz-Casares FC, Feliciangeli E, Torres Melero J, Barrios P, Morales R, Ramos I, Ortega G, Camps B, González-Bayón L, Bretcha-Boix P, Farré-Alegre J, González-Moreno S, Gil J. Morbidity and mortality outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients aged 75 years and over: Spanish Group of Peritoneal Cancer Surgery (GECOP) multicenter study. Surg Oncol. 2016;25:111–6.

    Article  CAS  Google Scholar 

  27. Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg. 2012;256:235–44.

    Article  Google Scholar 

  28. Hill GE, Frawley WH, Griffith KE, et al. Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. J Trauma. 2003;54:908–14.

    Article  Google Scholar 

  29. Simkens GA, van Oudheusden TR, Luyer MD, et al. Serious postoperative complications affect early recurrence after cytoreductive surgery and HIPEC for colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2015;22:2656–62.

    Article  Google Scholar 

  30. Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–9.

    Article  Google Scholar 

  31. Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation. Nature. 2008;454:436–44.

    Article  CAS  Google Scholar 

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Author information

Author notes

  1. F. C. Muñoz-Casares

    Present address: Hospital Universtiario Virgen del Rocio, Sevilla, Spain

Authors and Affiliations

  1. Hospital Clínico, Universitario Virgen De La Arrixaca, Carretera Madrid-Cartagena S/N, El Palmar, CP: 30120, Murcia, Spain

    P. A. Cascales-Campos, V. López-López & J. Gil

  2. IMIB-Arrixaca, Murcia, Spain

    P. A. Cascales-Campos, V. López-López & J. Gil

  3. Hospital Universitario De Torrecárdenas, Almería, Andalucia, Spain

    J. Torres-Melero

  4. Hospital Universitario Reina Sofía, Córdoba, Andalucia, Spain

    A. Arjona & F. C. Muñoz-Casares

  5. Hospital De Sant Joan De Espi Moises Broggi, Sant Joan De Espi, Cataluña, Spain

    P. Barrios

  6. Hospital Universitario Son Espases, Palma de Mayorca, Islas Baleares, Spain

    R. Morales

  7. Hospital Universitario De Fuenlabrada, Madrid, Spain

    F. Pereira

  8. Hospital Quirón de Torrevieja, Alicante, Comunidad Valenciana, Spain

    P. Bretcha-Boix

  9. Hospital General Universitario Gregorio Marañón, Madrid, Spain

    L. González-Bayón

  10. MD Anderson Cancer Center, Madrid, Spain

    S. González-Moreno

Authors
  1. P. A. Cascales-Campos
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  2. V. López-López
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Corresponding author

Correspondence to P. A. Cascales-Campos.

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The authors declare that they have no conflict of interest.

Ethical approval

The current study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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All patients signed informed consent forms and were treated according to clinical protocol approved by the Institutional Review Board of each center.

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Cascales-Campos, P.A., López-López, V., Torres-Melero, J. et al. Survival outcomes in patients aged 75 years and over with peritoneal colorectal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): multicenter study of the Spanish Group of Peritoneal Cancer Surgery (GECOP). Clin Transl Oncol 22, 130–136 (2020). https://doi.org/10.1007/s12094-019-02124-9

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