OUTCOMES FOR CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY IN PATIENTS 65 YEARS OF AGE OR OLDER AT A HIGH VOLUME CENTER IN THE UNITED STATES
Athena Hsu*, Joel Baumgartner, Jula Veerapong, Andrew M. Lowy, Kaitlyn J. Kelly
Surgery, University of California San Diego, San Diego, CA
Background:Existing data on outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in elderly patients are limited. As government and private insurance companies view CRS/HIPEC with increasing scrutiny, we sought to evaluate outcomes of CRS/HIPEC in patients aged 65 years and older at a high volume center in the Unites States (U.S.).
Methods:All consecutive patients who underwent CRS/HIPEC for peritoneal carcinomatosis from from August 2007 through February 2018 were identified from a prospectively-maintained database.
Results:A total of 500 patients were identified, 105 of whom (21%) were age 65 or older at the time of surgery. Patients 65 or older had a higher Charlson Comorbidity Index (26% > 0 versus 15%, p = 0.005) and slightly lower serum albumin levels (4.2 versus 4.3 gm/dL, p = 0.048) at baseline. There were no differences in gender, BMI, primary tumor site, peritoneal carcinomatosis index (PCI), completeness of cytoreduction score (CC-score), operative time, or estimated blood loss between patients <65 and those 65 or older. In terms of short-term outcomes, there were no differences in ICU admission, length of stay, or inpatient mortality. Patients 65 or older had greater 60-day Clavien grade I/II morbidity (58% versus 43%, p<0.05). There were no differences in inpatient mortality, or inpatient or 60-day Clavien grade III/IV morbidity (13% vs 17%, p=0.23). In the subsets of patients with appendiceal and colon primary tumors, there were no differences in progression free (PFS) or overall survival (OS) between patients <65 or those 65 or older.
Conclusions:CRS and HIPEC are safe and result in favorable long-term oncologic outcomes in selected patients 65 years of age or older.
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