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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2017

01-04-2017 | Gastrointestinal Oncology

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases

Authors: Mashaal Dhir, MBBS, Lekshmi Ramalingam, MD, Yongli Shuai, MS, Sam Pakrafter, MD, Heather L. Jones, MPA-C, Melissa E. Hogg, MD, Amer H. Zureikat, MD, Matthew P. Holtzman, MD, Steven A. Ahrendt, MD, Nathan Bahary, MD, James F. Pingpank, MD, Herbert J. Zeh, MD, David L. Bartlett, MD, Haroon A. Choudry, MBBS

Published in: Annals of Surgical Oncology | Issue 4/2017

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Abstract

Background

Several studies suggest that young patients may derive less oncologic benefit from surgical resection of cancers compared with older patients. We hypothesized that young patients may have worse outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for peritoneal metastases.

Methods

Perioperative and oncologic outcomes in adolescent and young adults (AYA), defined as younger than age 40 years (n = 135), undergoing CRS/HIPEC between 2001 and 2015 were reviewed and compared with middle-aged adults, defined as aged 40–65 years (n = 684).

Results

The two groups were similar with regards to perioperative characteristics except that AYA were more likely to be symptomatic at presentation (65.2 vs. 50.9%, p = 0.003), had lower Charleson comorbidity index (median 6 vs. 8, p < 0.001), were less likely to receive neoadjuvant chemotherapy (32.8 vs. 42.5%, p = 0.042), and had longer operative times (median 543 vs. 493 min, p = 0.010). Postoperative Clavien–Dindo grade 3–4 morbidity was lower in AYA (17 vs. 26%, p = 0.029), and they required fewer reoperations for complications (3.7 vs. 10.4%, p = 0.014). AYA had longer median overall survival (103.6 vs. 73.2 months, p = 0.053). In a multivariate Cox regression analysis, age was an independent predictor of improved overall survival [hazard ratio 0.705; 0.516–0.963, p = 0.028].

Conclusions

Young patients with peritoneal metastases derive similar benefits from CRS/HIPEC as middle-aged patients. Young age should not be a deterrent to consideration of CRS/HIPEC for peritoneal metastases.
Appendix
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Metadata
Title
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases
Authors
Mashaal Dhir, MBBS
Lekshmi Ramalingam, MD
Yongli Shuai, MS
Sam Pakrafter, MD
Heather L. Jones, MPA-C
Melissa E. Hogg, MD
Amer H. Zureikat, MD
Matthew P. Holtzman, MD
Steven A. Ahrendt, MD
Nathan Bahary, MD
James F. Pingpank, MD
Herbert J. Zeh, MD
David L. Bartlett, MD
Haroon A. Choudry, MBBS
Publication date
01-04-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5689-y

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