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Introduction: Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS-HIPEC) can prolong survival in patients with advanced gastrointestinal neoplasms confined to the peritoneal cavity. To date, no prospective studies have addressed the feasibility of this procedure in patients of advanced age. As a population, patients of advanced age are at higher risk for perioperative complications following any major abdominal surgery. It has been suggested in the literature that advanced age may be a contraindication to this potentially life-saving procedure. We sought to better quantify the effects of advanced age on outcomes following CRS-HIPEC.
Methods: All patients who underwent pre-operative evaluation for CRS-HIPEC from 2007 to 2012 were reviewed for inclusion in the study. Patients for whom adequate cytoreduction could not be achieved (and therefore intraperitoneal chemotherapy was not provided) were excluded from the study. The patients for whom CRS-HIPEC was performed were subsequently grouped and analyzed according to age at time of surgery. Demographic, operative, and post-operative data was prospectively collected. Informed consent was obtained and the study received institutional review board approval.
Results: Complete follow-up information was available for 99 patients. There were no statistically significant differences in 30-day mortality. Table 1 summarizes measured outcomes. Older patients had longer lengths of stay. Differences in cardiac and pulmonary function were most affected by age. Patients over age 70 were less likely to be extubated in the first 24 hours following surgery. Cardiac arrhythmia (i.e. atrial fibrillation) and post-operative delirium were seen more often in patients over age 70. There were no statistically significant differences among age groups regarding infection, post-operative transfusion requirement, renal dysfunction, or thrombotic/thromboembolic events.
Conclusions: Patients of advanced age are more likely to develop pulmonary complications, cardiac dysrhythmias, and delirium following CRS-HIPEC, as compared to younger patients. This may contribute to overall longer lengths of stay for patients of advanced age following this procedure. However, in our analysis, differences in morbidity between age groups had no effect on post-operative mortality. We conclude that CRS-HIPEC can be safely performed in patients of advanced age.

	Group I - <50 years	p value [Group I vs Group IV]	Group II - 50-59.9 years	p value [Group II vs Group IV]	Group III - 60-69.9 years	p value [Group III vs Group IV]	Group IV - >70 years
Total LOS (days)	9.77	0.035	9.5	0.098	12.59	0.42	16.91
Total ICU LOS (days)	4.03	0.81	4.03	0.54	2.42	0.18	3.27
Extubated within 24 hrs of surgery	38.5%	0.19	25.9%	0.029	45.4%	0.63	18.2%
Mechanical ventilation >48 hrs	7.7%	0.32	11.1%	0.57	4.5%	0.21	18.2%
Wound infection	5.1%	0.45	0	-	9.1%	0.32	0
Intra-abdominal infection	15.4%	0.67	3.7%	0.46	13.6%	0.78	9.1%
Post-operative pRBC transfusion	33.3%	0.47	48.1%	0.88	50%	0.81	45.4%
Deep vein thrombosis	5.1%	0.63	0	0.12	9.1%	1.00	9.1%
Pulmonary embolism	0	-	0	-	4.5%	0.32	0
Acute kidney injury (creatinine >2.0)	5.1%	0.45	7.4%	0.37	0	-	0
Cardiac arrhythmia	2.6%	0.007	3.7%	0.032	4.5%	0.063	27.3%
Acute myocardial infarction	0	-	0	-	0	-	0
Post-operative delirium	2.6%	0.056	3.7%	0.079	0	0.061	9.1%

LOS = length of stay