title: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases.
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.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Mashaal
authors.initials: M
authors.lastname: Dhir
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Ramalingam
authors.affiliation: Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Yongli
authors.initials: Y
authors.lastname: Shuai
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Pakrafter
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Jones
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Holtzman
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Ahrendt
authors.affiliation: Division of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Bahary
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. choudrymh@upmc.edu.
authors.forename: Haroon A
authors.initials: HA
authors.lastname: Choudry
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001063:Appendiceal Neoplasms / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000473:pathology*; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral / Q000379:methods; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents