Short-term outcomes in older patients with peritoneal malignancy treated with cytoreductive surgery and HIPEC: Experience with 245 patients from a national centre |
| |
| Institution: | 1. National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland;2. Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland;3. Department of Anaesthesiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland;4. Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, Basingstoke, UK;1. Department of Surgical Oncology, Homi Bhabha Cancer Hospital, Varanasi, India;2. Colorectal Division, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India;1. Division of Thoracic Surgery, Brigham and Women''s Hospital, Boston, MA, USA;2. Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China;3. Department of Data Sciences, Dana Farber Cancer Institute, Boston, USA;4. Department of Pathology, Brigham and Women''s Hospital, Boston, MA, USA;1. Department of Gastroenterological Surgery, Section for Surgical Oncology, Norwegian Radium Hospital, Oslo University Hospital, Norway;2. Faculty of Medicine, University of Oslo, Norway;3. Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Norway;4. Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Norway;1. Department of Prenatal Diagnosis and Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, 310008, China;2. Department of Head, Neck & Thyroid Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310000, China;3. Department of Radiology, The 903 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang, 310000, China;4. Department of Breast Surgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, 310000, China;1. Department of Gynecology and Obstetrics of Parma, 43125, Parma, Italy;2. Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy;1. TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;2. Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;3. Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden;4. Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden |
| |
| Abstract: | BackgroundCytoreductive Surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the optimal management of selected patients with peritoneal malignancy. There is limited published evidence on outcomes in older patients treated by this complex therapeutic strategy.MethodsA retrospective review of a prospective database of all patients who underwent CRS with HIPEC in a single institution over seven years. A comparative analysis of outcomes in patients under 65 undergoing CRS and HIPEC with patients ≥65 years was performed. The key endpoints were morbidity, mortality, reintervention rate and length of stay in the high dependency/intensive care (HDU/ICU) units.ResultsOverall, 245 patients underwent CRS and HIPEC during the study period, with 76/245 (31%) ≥65 years at the time of intervention. Tumour burden measured by the peritoneal carcinomatosis index (PCI) score was a median of 11 for both groups. Median length of hospital stay in the ≥65-year-old group was 14.5 days versus 13 days in the <65-year-old group (1p = 0.01). Patients aged ≥65-years spent a median of one more day in the critical care unit 1(p = 0.001). Significant morbidity (Clavien-Dindo ≥ Grade IIIa) was higher in the ≥65-year than the <65-year group (18.4% versus 11.2%). There were no perioperative deaths in the ≥65-year group.ConclusionThis study demonstrates higher perioperative major morbidity in ≥65-year group, but with low mortality in patients undergoing CRS/HIPEC for disseminated intraperitoneal malignancy. This increased morbidity does not translate into higher rates of re-interventions and highlights the importance of optimal patient selection. |
| |
| Keywords: | Advanced abdominopelvic cancer Peritoneal malignancy Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Surgical outcomes |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
