Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study.
Details
Serval ID
serval:BIB_168908DCC97C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study.
Journal
Annals of surgical oncology
Working group(s)
BIG-RENAPE and RENAPE Working Groups
Contributor(s)
Abba J., Bakrin N., Balagué G., Barrau V., Rejeb H.B., Bibeau F., Bonnefoy I., Bouzard D., Bricault I., Carrère S., Carretier M., Chassang M., Chevallier A., Courvoisier T., Cotte E., Dartigues P., Desolneux G., Dohan A., Dromain C., Dubreuil J., Dumont F., Durand-Fontanier S., Elias D., Eveno C., Evrard S., Facy O., Faruch-Bilfeld M., Ferron G., Gagniere J., Geffroy D., Gilly F.N., Fontaine J., Goasguen N., Ghouti L., Guibal A., Heyd B., Hordonneau C., Isaac S., Jourdan-Enfer P., Kaci R., Karoui M., Labbé C., Lacroix J., Lang-Averous G., Laverriere M.H., Lefevre J., Lelong B., Leroux A., Loi V., Malhaire C., Mariani A., Mariani P., Mariette C., Mathiotte E., Meeus P., Mery E., Messager M., Nadeau C., Pellet O., Petorin C., Piessen G., Pirro N., Pocard M., Poizat F., Porcheron J., Poulet A., Rat P., Regimbeau J.M., Rousselot P., Rousset P., Sabbagh C., Serrano M., Servois V., Skanjeti A., Svrcek M., Tetreau R., Valette P.J., Valmary-Degano S., Vaudoyer D., Velasco S., Verriele-Beurrier V., Villeneuve L., Wernert R.
ISSN
1534-4681 (Electronic)
ISSN-L
1068-9265
Publication state
Published
Issued date
12/2016
Peer-reviewed
Oui
Volume
23
Number
Suppl 5
Pages
737-745
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
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.
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.
Pubmed
Create date
22/06/2017 15:14
Last modification date
20/08/2019 12:46
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