Abstract
Background
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) prolongs survival in selected patients with peritoneal metastases. Since this procedure is likely to be associated with increased morbidity and mortality, it remains controversial whether it is also suitable for patients older than 70 years.
Methods
Consecutive patients with radiographic evidence of peritoneal metastases (PM) were scheduled for CRS and HIPEC at the Comprehensive Cancer Center, University Hospital Tübingen, Germany. Clinical data were retrospectively analyzed categorizing patients with respect to age into elderly (age ≥ 70) and non-elderly patients (age < 70).
Results
Between June 2005 and March 2014, 381 patients with a median age of 55 [14-77] years could be enrolled with 29 patients (8 %) being at least 70 years old. Both groups were comparable for tumor-related parameters including PCI, CC-status, time in operating room, and visceral resections. However, there was a difference in patient-related factors such as cardio-pulmonary comorbidities and ASA score. We found no difference in overall and recurrence-free survival between the two groups. Surgery-related mortality was 0.9 % in patients younger than 70 years whereas no patient died in the elderly group. Overall morbidity was 47 % in the younger and 76 % in the elderly group (p = 0.048). There was no difference in Clavien-Dindo grade III–IV morbidity. Logistic regression analysis proved age as an independent risk factor for increased overall morbidity in elderly patients.
Conclusion
In elderly patients, CRS and HIPEC are associated with increased overall morbidity but neither Dindo III–IV morbidity nor surgery-related mortality.
Similar content being viewed by others
References
Yan TD, Black D, Sugarbaker PH, Zhu J, Yonemura Y, Petrou G, Morris DL (2007) A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer. Ann Surg Oncol 14:2702–2713
Yang XJ, Huang CQ, Suo T, Mei LJ, Yang GL, Cheng FL, Zhou YF, Xiong B, Yonemura Y, Li Y (2011) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase iii randomized clinical trial. Ann Surg Oncol 18:1575–1581
Yonemura Y, Bandou E, Kinoshita K, Kawamura T, Takahashi S, Endou Y, Sasaki T (2003) Effective therapy for peritoneal dissemination in gastric cancer. Surg Oncol Clin N Am 12:635–648
Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H et al (2003) 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 21:3737–3743
Glehen O, Kwiatkowski F, Sugarbaker PH et al (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 22:3284–3292
Elias D, Gilly F, Boutitie F, Quenet F, Bereder JM, Mansvelt B et al (2010) Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric french study. J Clin Oncol 28:63–68
Chua TC, Yan TD, Smigielski ME, Zhu KJ, Ng KM, Zhao J, Morris DL (2009) Long-term survival in patients with pseudomyxoma peritonei treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy: 10 years of experience from a single institution. Ann Surg Oncol 16:1903–1911
Bijelic L, Jonson A, Sugarbaker PH (2007) Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer. Ann Oncol 18:1943–1950
Chua TC, Robertson G, Liauw W, Farrell R, Yan TD, Morris DL (2009) Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in ovarian cancer peritoneal carcinomatosis: systematic review of current results. J Cancer Res Clin Oncol 135:1637–1645
Yan TD, Deraco M, Baratti D et al (2009) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol 27:6237–6242
Klaver YL, Chua TC, de Hingh IH, Morris DL (2012) Outcomes of elderly patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for colorectal cancer peritoneal carcinomatosis. J Surg Oncol 105:113–118
Spiliotis JD, Halkia E, Boumis VA, Vassiliadou DT, Pagoulatou A, Efstathiou E (2014) Cytoreductive surgery and HIPEC for peritoneal carcinomatosis in the elderly. Int J Surg Oncol 2014:987475
Votanopoulos KI, Newman NA, Russell G, Ihemelandu C, Shen P, Stewart JH, Levine EA (2013) 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 20:3497–3503
Adam R, Frilling A, Elias D, Laurent C, Ramos E, Capussotti L, Poston GJ, Wicherts DA, de Haas RJ (2010) Liver resection of colorectal metastases in elderly patients. Br J Surg 97:366–376
Elias D, Delperro JR, Sideris L, Benhamou E, Pocard M, Baton O, Giovannini M, Lasser P (2004) Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol 11:518–521
Sugarbaker PH (1996) Peritonectomy procedures. Cancer Treat Res 82:235–253
Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Bureau of the Census (2008) International data base. U.S.: Bureau of the Census, Washington
Wicke C, Bachinger A, Coerper S, Beckert S, Witte MB, Königsrainer A (2009) Aging influences wound healing in patients with chronic lower extremity wounds treated in a specialized wound care center. Wound Repair Regen 17:25–33
Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, DiPietro L, Falanga V, Fife C, Gardner S, Grice E, Harmon J, Hazzard WR, High KP, Houghton P, Jacobson N, Kirsner RS, Kovacs EJ, Margolis D, McFarland Horne F, Reed MJ, Sullivan DH, Thom S, Tomic-Canic M, Walston J, Whitney JA, Williams J, Zieman S, Schmader K (2015) Chronic wound repair and healing in older adults: current status and future research. J Am Geriatr Soc 63:427–438
Höer J, Lawong G, Klinge U, Schumpelick V (2002) Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 73:474–480
Rodríguez-Hermosa JI, Codina-Cazador A, Ruiz B, Roig J, Gironès J, Pujadas M, Pont J, Aldeguer X, Acero D (2005) Risk factors for acute abdominal wall dehiscence after laparotomy in adults. Cir Esp 77:280–286
Bucknall TE, Cox PJ, Ellis H (1982) Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed) 284:931–933
Riou JP, Cohen JR, Johnson H Jr (1992) Factors influencing wound dehiscence. Am J Surg 163:324–330
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Beckert, S., Struller, F., Horvath, P. et al. Overall morbidity but not mortality is increased in elderly patients following cytoreductive surgery and HIPEC. Langenbecks Arch Surg 400, 693–698 (2015). https://doi.org/10.1007/s00423-015-1325-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-015-1325-8