title: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in elderly patients. A systematic literature review.
abstract: The objective of this review was to evaluate morbidity, mortality and survival outcomes of elderly patients with peritoneal carcinomatosis. A systematic literature search and standardized data collection of primary research publications until June 2016 on morbidity, mortality and survival outcomes in adults aged 65 and older with peritoneal carcinomatosis treated with cytoreduction and HIPEC was performed, using PubMed, EMBASE, Scopus, ClinicalTrials.gov and Cochrane. Bibliographies of relevant reports were also hand-searched to identify all potentially eligible studies. Nine studies were included. Severe morbidity of all elderly patients ranges from 17% to 56% in centers with high experience. In-hospital and 30-day mortality ranges from 0% to 8%. In only two studies were the differences in morbidity and mortality statistically significant related to the control group. However, older adults undergoing cytoreductive surgery and HIPEC consistently had lower survival rates across all study settings and procedure types than younger individuals. In studies that stratified for elderly patients, PCI, completeness of cytoreduction, tumor histology and albumin levels were predictive factors of survival. None of these studies examined quality of life, which precludes including functional outcomes in this review. Differences in exposures, outcomes, and data presented in the studies did not allow for quantification of association using a meta analysis.
authors.affiliation: Peritoneal Carcinomatosis Unit, Surgery Department, Universitary Clinic Hospital Virgen de la Arrixaca, Murcia, IMIB, Arrixaca, Spain.
authors.forename: V
authors.initials: V
authors.lastname: López-López
authors.affiliation: Peritoneal Carcinomatosis Unit, Surgery Department, Universitary Clinic Hospital Virgen de la Arrixaca, Murcia, IMIB, Arrixaca, Spain. Electronic address: cascalescirugia@gmail.com.
authors.forename: P A
authors.initials: PA
authors.lastname: Cascales-Campos
authors.affiliation: Department of General Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: M A
authors.initials: MA
authors.lastname: Schneider
authors.affiliation: Peritoneal Carcinomatosis Unit, Surgery Department, Universitary Clinic Hospital Virgen de la Arrixaca, Murcia, IMIB, Arrixaca, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Gil
authors.affiliation: Peritoneal Carcinomatosis Unit, Surgery Department, Universitary Clinic Hospital Virgen de la Arrixaca, Murcia, IMIB, Arrixaca, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Gil
authors.affiliation: Complutense University of Madrid, Spain.
authors.forename: N Rodriguez
authors.initials: NR
authors.lastname: Gomez-Hidalgo
authors.affiliation: Peritoneal Carcinomatosis Unit, Surgery Department, Universitary Clinic Hospital Virgen de la Arrixaca, Murcia, IMIB, Arrixaca, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000628:therapy*; D011788:Quality of Life
keywords: Cytoreduction; Elderly; HIPEC; Morbidity; Survival