title: Indications for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in elderly patients with peritoneal malignancy.
abstract: OBJECTIVE
  A combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is effective for some peritoneal malignancies. However, the indications for elderly patients remain unclear, with substantial postoperative morbidity and mortality being problematic.
  
  
  METHODS
  Clinical data were analyzed in 42 patients undergoing CRS + HIPEC for peritoneal malignancy. The primary tumor was located in the appendix in 32 cases and elsewhere in 10 cases. Operative results and survival data were compared between patients aged ≥70 and <70 years.
  
  
  RESULTS
  Fourteen patients were older than 70 years. Elderly patients had a higher peritoneal cancer index (32.0 vs. 21.5), higher CA19-9 level (189.0 vs. 28.1), and higher frequency of grade 4-5 complications (5/9 vs. 2/26) than the younger patients. Grade 4-5 respiratory failure occurred in three elderly patients. There was a significant difference of postoperative survival between the elderly patients and younger patients, with 5-year survival rates being 41.3 and 74.2%, respectively (p = 0.0166). The poor prognosis of elderly patients was related to the higher frequency of grade 4-5 complications.
  
  
  CONCLUSIONS
  Elderly patients were referred for treatment with more advanced disease than younger patients. An age ≥70 years was associated with more frequent grade 4-5 complications and worse survival. Performing CRS + HIPEC in elderly patients should be considered carefully due to the risk of severe complications, especially respiratory failure.
authors.affiliation: Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan. kitait@kuhp.kyoto-u.ac.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kitai
authors.affiliation: Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Yamanaka
authors.affiliation: Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Miyauchi
authors.affiliation: Department of Surgery, Nara Social Insurance Hospital, Nara, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kawashima
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Cytoreductive surgery; Elderly patient; Peritoneal malignancy; Postoperative complication; Respiratory failure