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.
BACKGROUND
The aim of this study is to report the perioperative outcomes of cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in patients ≥75 years from a Spanish multi-institutional experience.


METHODS
This multi-institutional retrospectively analyzed a prospectively collected clinical data from 10 Spanish hospitals that are part of the Spanish Group Peritoneal Cancer Surgery (GECOP). We assessed postoperative morbidity rates and performed univariate and multivariate analyses of factors associated with overall (grade I-IV) and major (grade III-IV) postoperative morbidity.


RESULTS
A total of 85 patients aged ≥75 years were included. Forty six postoperative adverse events were detected in 37 patients (43.5%). Twenty five complications in 20 patients (23.5%) were mild (grade I-II) and 16 complications in 12 patients (14.1%) were moderate-severe (grade III-IV). Five patients died in the first 90 days after the procedure (5.9%). After multivariate analysis, independent factors associated with postoperative complications were: PCI> 12 (OR: 4.14, 95% CI 1.22-14.12, p = 0.043) and the need for perioperative blood transfusion (OR: 14.91, 95% CI 3.87-57.46, p < 0.001). Regarding grade III-IV complications, after multivariate analysis, the presence of preoperative albumin levels <3.5 mgr/dl (OR: 9.15, 95% CI 1.38-60.57, p = 0.017), need for diaphragmatic peritonectomy procedures (OR: 11.32, 95% CI 1.40-91.32, p = 0.023) and perioperative blood transfusion (OR: 8.58, 95% CI 1.44-51.16, p = 0.018) were independent factors.


CONCLUSIONS
Cytoreductive surgery and performing HIPEC by experienced groups in selected patients aged ≥75 years can be performed with morbidity and mortality similar to that described in the literature.
Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain. Electronic address: cascalescirugia@gmail.com.
P A
PA
Cascales-Campos
Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain.
V
V
López-López
Hospital Universitario Reina Sofía, Córdoba, Andalucia, Spain.
F C
FC
Muñoz-Casares
Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain.
E
E
Feliciangeli
Hospital Universitario De Torrecárdenas, Almería, Andalucia, Spain.
J
J
Torres Melero
Hospital De Sant Joan De Espi Moises Broggi, Sant Joan De Espi, Cataluña, Spain.
P
P
Barrios
Hospital Universitario Son Espases, Palma de Mayorca, Islas Baleares, Spain.
R
R
Morales
Hospital De Sant Joan De Espi Moises Broggi, Sant Joan De Espi, Cataluña, Spain.
I
I
Ramos
Hospital Universitario De Fuenlabrada, Madrid, Spain.
G
G
Ortega
Hospital General Universitario, Valencia, Valencia, Spain.
B
B
Camps
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
L
L
González-Bayón
Hospital Quirón de Torrevieja, Alicante, Comunidad Valenciana, Spain.
P
P
Bretcha-Boix
Hospital Quirón de Torrevieja, Alicante, Comunidad Valenciana, Spain.
J
J
Farré-Alegre
MD Anderson Cancer Center, Madrid, Spain.
S
S
González-Moreno
Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain.
J
J
Gil
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000401:mortality*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000401:mortality*; D008297:Male; D009017:Morbidity; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
Cytoreductive; Elderly; HIPEC; Morbidity; Mortality