Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study.
This study was designed to identify factors associated with morbidity and mortality in patients older than 70 years who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC).



Major surgery is associated with higher morbidity and mortality in elderly patients. For PC, CRS and HIPEC is the only current potential curative therapy, but the risks inherent to this patient population have called its benefits into question.



We retrospectively analyzed a multi-center database from 1989 to 2015. All patients who underwent CRS and HIPEC for PC were selected and patients older than 70 years were matched 1:4 with a younger cohort according to cancer origin, peritoneal cancer index (PCI), and completeness of cytoreduction. Major morbidity and mortality were analyzed.



Of 2328 patients, 188 patients older than aged 70 years were matched with 704 younger patients. Patients older than aged 70 years demonstrated a higher American Society of Anesthesiologist score (≥ASA III 10.8 vs. 6.6 %, p = 0.008). There was no difference in overall 90-day morbidity (≥70: 45.7 % vs. <70: 44.5 %; p = 0.171); however, patients older than 70 years had significantly more cardiovascular complications (13.8 vs. 9.2 %, p = 0.044). Differences between the older and younger cohorts failed to reach significance for 90-day mortality (5.4 and 2.7 %, respectively; p = 0.052), and failure-to-rescue (11.6 and 6.1 %, respectively; p = 0.078). In multivariate analysis, PCI > 7 (95 % CI 1.051-5.798, p = 0.038) and HIPEC duration (95 % CI 1.106-6.235, p = 0.028) were independent factors associated with morbidity in elderly patients.



CRS and HIPEC appear feasible for selected patients older than aged 70 years, albeit with a higher risk of medical complications associated with increased mortality.
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.|King Abdullah Scholarship Program, Saudi Arabian Cultural Bureau, Paris, France.
Mohammad
M
Alyami
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.
Peter
P
Lundberg
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.
Vahan
V
Kepenekian
Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France.
Diane
D
Goéré
Department of Digestive Surgery, Archet 2 University Hospital, Nice, France.
Jean-Marc
JM
Bereder
Department of Surgery, Louis Mourier University Hospital, Colombes, France.
Simon
S
Msika
Department of Digestive Surgery, Angers University Hospital, Angers, France.
Gérard
G
Lorimier
Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France.
François
F
Quenet
Department of Surgical Oncology, Claudius Regaud Institute IUTC, Toulouse, France.
Gwenaël
G
Ferron
Department of Surgical Oncology, ICO René Gauducheau Cancer Center, Saint-Herblain, France.
Emilie
E
Thibaudeau
Department of Digestive Surgery, St Etienne University Hospital, Saint-Étienne, France.
Karine
K
Abboud
Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, Paris, France.
Réa
R
Lo Dico
Department of Digestive Surgery, Minjoz University Hospital, Besançon, France.
Delphine
D
Delroeux
Department of Digestive Surgery, Hautepierre University Hospital, Strasbourg, France.
Cécile
C
Brigand
Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France.
Catherine
C
Arvieux
Department of Surgical Oncology, Institut de Cancérologie de Lorraine, CRAN CNRS UMR 7039, Université de Lorraine, Vandœuvre-Lès-Nancy, France.
Frédéric
F
Marchal
Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France.
Jean-Jacques
JJ
Tuech
Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France.
Jean-Marc
JM
Guilloit
Department of Surgical Oncology, Bergonie Institute, Bordeaux, France.
Frédéric
F
Guyon
Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France.
Patrice
P
Peyrat
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Denis
D
Pezet
Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France.
Pablo
P
Ortega-Deballon
Department of Digestive and General Surgery, G. Pompidou European Hospital, Paris, France.
Franck
F
Zinzindohoue
Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France.
Cécile
C
de Chaisemartin
Department of Digestive Surgery, Robert Debré University Hospital, Reims, France.
Reza
R
Kianmanesh
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.|EMR 37-38, Lyon 1 University, Lyon, France.
Olivier
O
Glehen
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France. guillaume.passot@chu-lyon.fr.|EMR 37-38, Lyon 1 University, Lyon, France. guillaume.passot@chu-lyon.fr.|Département Chirurgie Générale, Digestive et Endocrinienne, CHU Lyon Sud, Pierre-Bénite, France. guillaume.passot@chu-lyon.fr.
Guillaume
G
Passot
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000209:etiology; D016022:Case-Control Studies; D002423:Cause of Death; D003131:Combined Modality Therapy / Q000009:adverse effects; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D000067248:Failure to Rescue, Health Care; D005260:Female; D006304:Health Status; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult