title: Outcomes for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the elderly.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) has gained acceptance in the treatment of peritoneal carcinomatosis (PC) with reported morbidity and mortality rates of 27-56% and 0-11% respectively. The safety and outcome of such major operation in the elderly remains unclear. We report our experience at a high volume tertiary center.
  
  
  METHODS
  A total of 170 consecutive patients underwent CRS-HIPEC for peritoneal carcinomatosis between March 2007 and July 2012. Mitomycin C (88.8%) was administered intraperitoneally at 42 °C for 90 min. Patients were categorized into two groups according to the age at the time of surgery: Group 1 (≤65 years-old) and Group 2 (>65 years-old). Differences between the groups were analyzed. Univariate and multivariate analyses were performed to identify variables associated with major morbidity.
  
  
  RESULTS
  Of the 170 patients, 35 were older than 65 years. The two most common tumor sites were colorectal and appendiceal cancer. The perioperative morbidity and mortality rates in the elderly were 18.8% and 8.6% respectively. Gender, tumor type, estimated blood loss >400 mL, intraoperative blood transfusion, operative time >6 h, bowel anastomosis, intraoperative PCI >16, and extent of cytoreduction (Δ PCI) were not associated with major morbidity in the older group (p > 0.05). At a median follow-up of 15.7 months (0.2-53.5 months), recurrence rate for colorectal/appendiceal PC at 1 year was 48.0% in Group 1 and 44.3% in Group 2 (p = NS). Median survival for the colorectal/appendiceal carcinomatosis patients in Group 1 (n = 81) was 29.79 (SE 4.7) months and in Group 2 (n = 20) was 21.2 (SE 3.0) months, (p = 0.06, NS).
  
  
  CONCLUSIONS
  CRS-HIPEC procedures for peritoneal carcinomatosis in the elderly demonstrate comparable perioperative outcome in well-selected patients. Optimal cytoreduction was achieved in the majority of cases and survival was not significantly different from that of the younger group.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Mount Sinai School of Medicine, New York, NY, USA. ptabrizian@hotmail.com
authors.forename: Parissa
authors.initials: P
authors.lastname: Tabrizian
authors.forename: Ghalib
authors.initials: G
authors.lastname: Jibara
authors.forename: Brian
authors.initials: B
authors.lastname: Shrager
authors.forename: Bernardo
authors.initials: B
authors.lastname: Franssen
authors.forename: Ming-Jim
authors.initials: MJ
authors.lastname: Yang
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
authors.forename: Spiros
authors.initials: S
authors.lastname: Hiotis
authors.forename: Daniel
authors.initials: D
authors.lastname: Labow
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000401:mortality*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000401:mortality*; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate
keywords: Cytoreductive surgery; Elderly; Hyperthermic intraperitoneal chemotherapy; Peritoneal carcinomatosis