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Background: Cytoreduction Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is being used with increasing frequency to treat patients with peritoneal carcinomatosis from various malignancies. The safety of this procedure in older patients has not been established. We sought to determine the morbidity and mortality of CRS and HIPEC in patients ≥ 65 years of age.Methods: A retrospective review was performed of all patients who underwent CRS +/- HIPEC at a single institution between 9/1/2004 and 9/1/2010. Data were collected on patient and tumor characteristics, operative factors, and postoperative morbidity and mortality. This study was approved by the Institutional Review Board.Results: Of 175 patients who underwent CRS +/- HIPEC, 30 patients (18 males, 12 females) were ≥ 65 years of age (median 67, range 65-86). Patients were treated for various malignancies including appendiceal (9, 30%), mesothelioma (5, 17%), colorectal (5, 17%), ovarian (4, 13%), gastric (2, 7%), primary peritoneal (2, 7%), endometrial (1, 3%), malignant solitary fibrous tumor (1, 3%), and an unknown gastrointestinal primary (1, 3%). The American Society of Anesthesiologists score was 3 or greater in 28 patients (93%). Median operative time was 426 minutes (range 150-666) and median blood loss was 800 milliliters (range 150-3000). Seventeen patients (57%) required intraoperative blood transfusion (median # units 3, range 1-9). Median number of organs resected was 4 (range 1-9). Completeness of cytoreduction (CCR) was CCR-0 in 18 patients (60%), CCR-1 in 5 patients (17%), and CCR-2 in 7 patients (23%). HIPEC was performed in 26 patients (87%). Eight patients (27%) required a stay in the intensive care unit (median duration 4 days, range 2-44), and the median hospital stay was 8 days (range 4-63). There were 19 grade 3 or higher (National Cancer Institute criteria) complications in 14 patients (47%, Table). The most common complication was bowel perforation/fistula (6 patients, 20%). Eight patients (27%) required reoperation. The overall morbidity was 63%. Two patients (7%) died of complications directly related to surgery at 5 and 44 days postoperatively.Conclusions: In this series of patients ≥ 65 years of age who underwent CRS +/- HIPEC, the morbidity and mortality was comparable to that previously reported in the literature (major morbidity 12-66%, mortality 1-12%). Given the potential for significant morbidity associated with this treatment, patient selection for this procedure is critical.
Complications of CRS +/- HIPEC

Complication Type	Grade
	1-2	3	4	5
Bowel perforation/fistula		1	3	2
Hemorrhage			1
Negative re-exploration			1
Wound	2		1
Partial small bowel obstruction		2
Intra-abdominal abscess		1
Pancreatic fistula	1
Urinary tract infection	1	3
Pneumonia		2
Line infection		1
Arrhythmia	2
Non-infectious pulmonary	2	1
Deep venous thrombosis	2
Fall	1
Total	11	11	6	2