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Analysis of Morbidity and Mortality of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients Age ≥ 65 Years
Keli Turner*, Susan B. Kesmodel, Cherif Boutros, H. Richard Alexander, Nader Hanna
Division of General and Oncologic Surgery, Department of Surgery, University of Maryland, Baltimore, MD
Background
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CS & HIPEC) is a complex surgical procedure that is utilized for treatment of patients with peritoneal carcinomatosis of various tumor histologies. Because of increasing life expectancy, the number of elderly patients referred for this procedure continues to rise. Given the potential for major morbidity and mortality rates, there is controversy regarding the suitability of elderly patients for CS & HIPEC.
Objective
To evaluate the morbidity and mortality of CS & HIPEC in patients ≥ 65 years of age.
Methods
Retrospective analysis of a prospectively maintained database between December 1, 2004 and March 1, 2013 revealed 321 patients who underwent CS & HIPEC at a single institution. 44 of these patients were ≥ 65 years of age and constituted the study group. Maximal tumor debulking was achieved through a combination of partial or total organ resection, peritonectomy, and thermal ablation of metastases. HIPEC was performed using a closed technique with Mitomycin C for 60-90 minutes at temp range of 40-42 Celsius. Information on patient and tumor characteristics, operative data, and postoperative morbidity and mortality was collected. Patient complications were graded from 1 to 5 according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0.
Results
The median age was 67.5 (range: 65 - 86). Patients with ECOG status of 0, 1 and 2 constituted 66, 29.5 and 4.5% respectively. Surgeries were extensive with a median PCI of 20 (range: 0-35). The median duration of surgery was 420 minutes (range: 229-720) with a median estimated blood loss of 400 milliliters. The most common organs resected were the colon and spleen in 20 patients. The majority of patients had a complete (57%) or near complete (36%) cytoreduction. The median duration of initial hospitalization was 9 days (range: 5-136 days). Thirty day mortality was 4.5% as there were 2 mortalities at days 5 and 29. Complications occurred in 19 patients (45%) with grade 3 or 4 complications occurring in 10 patients (22.7%). The most common complication was pulmonary in 8 patients (19%). Re-operation was required in 5 patients (11.4%). Of the 42 discharged patients, 10 were sent to rehab (23.8%) with overall readmission rate of 14% (6 patients).
Conclusion
In the present study, the major morbidity and overall mortality of CS and HIPEC were 22.7% and 4.5%, respectively. This is similar to what has been previously reported in major gastrointestinal surgery. CS & HIPEC is a complex surgical procedure which can be performed safely in elderly patients with proper patient selection.
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