Annals of Surgical Oncology

, Volume 24, Issue 4, pp 875–883

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases

  • Mashaal Dhir
  • Lekshmi Ramalingam
  • Yongli Shuai
  • Sam Pakrafter
  • Heather L. Jones
  • Melissa E. Hogg
  • Amer H. Zureikat
  • Matthew P. Holtzman
  • Steven A. Ahrendt
  • Nathan Bahary
  • James F. Pingpank
  • Herbert J. Zeh
  • David L. Bartlett
  • Haroon A. Choudry
Gastrointestinal Oncology

DOI: 10.1245/s10434-016-5689-y

Cite this article as:
Dhir, M., Ramalingam, L., Shuai, Y. et al. Ann Surg Oncol (2017) 24: 875. doi:10.1245/s10434-016-5689-y

Abstract

Background

Several studies suggest that young patients may derive less oncologic benefit from surgical resection of cancers compared with older patients. We hypothesized that young patients may have worse outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for peritoneal metastases.

Methods

Perioperative and oncologic outcomes in adolescent and young adults (AYA), defined as younger than age 40 years (n = 135), undergoing CRS/HIPEC between 2001 and 2015 were reviewed and compared with middle-aged adults, defined as aged 40–65 years (n = 684).

Results

The two groups were similar with regards to perioperative characteristics except that AYA were more likely to be symptomatic at presentation (65.2 vs. 50.9%, p = 0.003), had lower Charleson comorbidity index (median 6 vs. 8, p < 0.001), were less likely to receive neoadjuvant chemotherapy (32.8 vs. 42.5%, p = 0.042), and had longer operative times (median 543 vs. 493 min, p = 0.010). Postoperative Clavien–Dindo grade 3–4 morbidity was lower in AYA (17 vs. 26%, p = 0.029), and they required fewer reoperations for complications (3.7 vs. 10.4%, p = 0.014). AYA had longer median overall survival (103.6 vs. 73.2 months, p = 0.053). In a multivariate Cox regression analysis, age was an independent predictor of improved overall survival [hazard ratio 0.705; 0.516–0.963, p = 0.028].

Conclusions

Young patients with peritoneal metastases derive similar benefits from CRS/HIPEC as middle-aged patients. Young age should not be a deterrent to consideration of CRS/HIPEC for peritoneal metastases.

Supplementary material

10434_2016_5689_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 48 kb)

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Mashaal Dhir
    • 1
  • Lekshmi Ramalingam
    • 1
  • Yongli Shuai
    • 2
  • Sam Pakrafter
    • 1
  • Heather L. Jones
    • 1
  • Melissa E. Hogg
    • 1
  • Amer H. Zureikat
    • 1
  • Matthew P. Holtzman
    • 1
  • Steven A. Ahrendt
    • 1
  • Nathan Bahary
    • 3
  • James F. Pingpank
    • 1
  • Herbert J. Zeh
    • 1
  • David L. Bartlett
    • 1
  • Haroon A. Choudry
    • 1
  1. 1.Division of Surgical OncologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department of BiostatisticsUniversity of PittsburghPittsburghUSA
  3. 3.Division of Medical OncologyUniversity of Pittsburgh Medical CenterPittsburghUSA

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