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01-12-2016 | Gastrointestinal Oncology

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study

Authors: Mohammad Alyami, MD, Peter Lundberg, MD, Vahan Kepenekian, MD, Diane Goéré, MD, PhD, Jean-Marc Bereder, MD, PhD, Simon Msika, MD, PhD, Gérard Lorimier, MD, François Quenet, MD, Gwenaël Ferron, MD, Emilie Thibaudeau, MD, Karine Abboud, MD, Réa Lo Dico, MD, Delphine Delroeux, MD, Cécile Brigand, MD, PhD, Catherine Arvieux, MD, PhD, Frédéric Marchal, MD, PhD, Jean-Jacques Tuech, MD, PhD, Jean-Marc Guilloit, MD, Frédéric Guyon, MD, Patrice Peyrat, MD, Denis Pezet, MD, PhD, Pablo Ortega-Deballon, MD, PhD, Franck Zinzindohoue, MD, PhD, Cécile de Chaisemartin, MD, Reza Kianmanesh, MD, Olivier Glehen, MD, PhD, Guillaume Passot, MD, PhD, on behalf of the BIG-RENAPE and RENAPE Working Groups

Published in: Annals of Surgical Oncology | Special Issue 5/2016

Abstract

Objective

This study was designed to identify factors associated with morbidity and mortality in patients older than 70 years who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC).

Background

Major surgery is associated with higher morbidity and mortality in elderly patients. For PC, CRS and HIPEC is the only current potential curative therapy, but the risks inherent to this patient population have called its benefits into question.

Methods

We retrospectively analyzed a multi-center database from 1989 to 2015. All patients who underwent CRS and HIPEC for PC were selected and patients older than 70 years were matched 1:4 with a younger cohort according to cancer origin, peritoneal cancer index (PCI), and completeness of cytoreduction. Major morbidity and mortality were analyzed.

Results

Of 2328 patients, 188 patients older than aged 70 years were matched with 704 younger patients. Patients older than aged 70 years demonstrated a higher American Society of Anesthesiologist score (≥ASA III 10.8 vs. 6.6 %, p = 0.008). There was no difference in overall 90-day morbidity (≥70: 45.7 % vs. <70: 44.5 %; p = 0.171); however, patients older than 70 years had significantly more cardiovascular complications (13.8 vs. 9.2 %, p = 0.044). Differences between the older and younger cohorts failed to reach significance for 90-day mortality (5.4 and 2.7 %, respectively; p = 0.052), and failure-to-rescue (11.6 and 6.1 %, respectively; p = 0.078). In multivariate analysis, PCI > 7 (95 % CI 1.051–5.798, p = 0.038) and HIPEC duration (95 % CI 1.106–6.235, p = 0.028) were independent factors associated with morbidity in elderly patients.

Conclusions

CRS and HIPEC appear feasible for selected patients older than aged 70 years, albeit with a higher risk of medical complications associated with increased mortality.

Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88(2):358–63.CrossRefPubMed

Sugarbaker PH, Cunliffe WJ, Belliveau J, de Bruijn EA, Graves T, Mullins RE, et al. Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. Sem Oncol. 1989;16(4 Suppl 6):83–97.

Gilly FN, Sayag AC, Carry PY, Braillon GG, James IM, Volloch AA, et al. Intra-Peritoneal Chemo-Hyperthermia (CHIP): a new therapy in the treatment of the peritoneal seedings. Preliminary report. Int Surg. 1991;76(3):164–7.PubMed

Chua TC, Moran BJ, Sugarbaker PH, Levine EA, Glehen O, Gilly FN, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449–56.CrossRefPubMed

Yan TD, Deraco M, Baratti D, Kusamura S, Elias D, Glehen O, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27(36):6237–42.CrossRefPubMed

Goere D, Malka D, Tzanis D, Gava V, Boige V, Eveno C, et al. Is there a possibility of a cure in patients with colorectal peritoneal carcinomatosis amenable to complete cytoreductive surgery and intraperitoneal chemotherapy? Ann Surg. 2013;257(6):1065–71.CrossRefPubMed

Chia CS, You B, Decullier E, Vaudoyer D, Lorimier G, Abboud K, et al. Patients with peritoneal carcinomatosis from gastric cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is cure a possibility? Ann Surg Oncol. 2016.

Lutz W, Sanderson W, Scherbov S. The coming acceleration of global population ageing. Nature. 2008;451(7179):716–9.CrossRefPubMed

Al-Refaie WB, Parsons HM, Henderson WG, Jensen EH, Tuttle TM, Vickers SM, et al. Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg. 2010;251(2):311–8.CrossRefPubMed

10.

Adam R, Frilling A, Elias D, Laurent C, Ramos E, Capussotti L, et al. Liver resection of colorectal metastases in elderly patients. Br J Surg. 2010;97(3):366–76.CrossRefPubMed

11.

Ide T, Miyoshi A, Kitahara K, Noshiro H. Prediction of postoperative complications in elderly patients with hepatocellular carcinoma. J Surg Res. 2013;185(2):614–9.CrossRefPubMed

12.

Melis M, Marcon F, Masi A, Pinna A, Sarpel U, Miller G, et al. The safety of a pancreaticoduodenectomy in patients older than 80 years: risk vs. benefits. HPB. 2012;14(9):583–8.

13.

Gerstenhaber F, Grossman J, Lubezky N, Itzkowitz E, Nachmany I, Sever R, et al. Pancreaticoduodenectomy in elderly adults: is it justified in terms of mortality, long-term morbidity, and quality of life? J Am Geriatrics Soc. 2013;61(8):1351–7.CrossRef

14.

Kim MG, Kim HS, Kim BS, Kwon SJ. The impact of old age on surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. Surg Endosc. 2013;27(11):3990–7.CrossRefPubMed

15.

Ahmed S, Stewart JH, Shen P, Votanopoulos KI, Levine EA. Outcomes with cytoreductive surgery and HIPEC for peritoneal metastasis. J Surg Oncol. 2014;110(5):575–84.CrossRefPubMed

16.

Macri A, Saladino E, Trimarchi G, Bartolo V, Rossitto M, Cannao A, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in elderly patients. In vivo (Athens, Greece). 2011;25(4):687–90.

17.

Klaver YLB, Chua TC, de Hingh IHJT, Morris DL. Outcomes of elderly patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for colorectal cancer peritoneal carcinomatosis. J Surg Oncol. 2012;105(2):113–8.CrossRefPubMed

18.

Tabrizian P, Jibara G, Shrager B, Franssen B, Yang MJ, Sarpel U, et al. Outcomes for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the elderly. Surg Oncol. 2013;22(3):184–9.CrossRefPubMed

19.

Votanopoulos KI, Newman NA, Russell G, Ihemelandu C, Shen P, Stewart JH, et al. Outcomes of Cytoreductive Surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients older than 70 years; survival benefit at considerable morbidity and mortality. Ann Surg Oncol. 2013;20(11):3497–503.CrossRefPubMed

20.

Spiliotis JD, Halkia E, Boumis VA, Vassiliadou DT, Pagoulatou A, Efstathiou E. Cytoreductive surgery and HIPEC for peritoneal carcinomatosis in the elderly. Int J Surg Oncol. 2014;2014:987475.PubMedPubMedCentral

21.

Cascales-Campos P, Gil J, Gil E, Feliciangeli E, Lopez V, Gonzalez AG, et al. Cytoreduction and HIPEC after neoadjuvant chemotherapy in stage IIIC-IV ovarian cancer. Critical analysis in elderly patients. Eur J Obst Gynecol Reprod Biol. 2014;179:88–93.

22.

Delotte J, Arias T, Guerin O, Boulahssass R, Bereder I, Bongain A, et al. Hyperthermic intraperitoneal chemotherapy for the treatment of recurrent ovarian cancer in elderly women. Acta Obstet Gynecol Scand. 2015;94(4):435–9.CrossRefPubMed

23.

Huang Y, Alzahrani NA, Alzahrani SE, Zhao J, Liauw W, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis in the elderly. World J Surg Oncol. 2015;13:262.CrossRefPubMedPubMedCentral

24.

Jacquet P, Sugarbaker P. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Peritoneal carcinomatosis: principles of management. Cancer Treatment Res. 1996;82:359–74.

25.

Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Ann Surg Oncol. 2007;14(1):128–33.CrossRefPubMed

26.

National Cancer Institute. Cancer Therapy Evaluation Program. Common terminology criteria for adverse events v3.0 (CTCAE). Available at: http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed 6 Oct 2013.

27.

Sugarbaker PH. Peritonectomy procedures. Cancer treatment and research. 2007;134:247–64.PubMed

28.

Faivre J, Lemmens VE, Quipourt V, Bouvier AM. Management and survival of colorectal cancer in the elderly in population-based studies. Eur J Cancer (Oxford, England: 1990). 2007;43(15):2279–84.

29.

Spiliotis J, Datsis AC, Vaxevanidou A, Lambropoulou E, Voutsina A, Chrysanthopoulos K, et al. Role of age on the outcome of liver surgery. A single institution experience. Surg Practice. 2009;13(2):32–5.

30.

Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med. 2001;134(8):637–43.CrossRefPubMed

31.

Pratt WB, Gangavati A, Agarwal K, Schreiber R, Lipsitz LA, Callery MP, et al. Establishing standards of quality for elderly patients undergoing pancreatic resection. Arch Surg (Chicago, Ill: 1960). 2009;144(10):950–6.

32.

Barrier A, Ferro L, Houry S, Lacaine F, Huguier M. Rectal cancer surgery in patients more than 80 years of age. Am J Surg. 2003;185(1):54–7.CrossRefPubMed

33.

Elias D, Delperro J-R, Sideris L, Benhamou E, Pocard M, Baton O, et al. Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol. 2004;11(5):518–21.CrossRefPubMed

34.

Chua TC, Yan TD, Saxena A, Morris DL. Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure? A systematic review of morbidity and mortality. Ann Surg. 2009;249(6):900–7.CrossRefPubMed

35.

McQuellon RP, Loggie BW, Lehman AB, Russell GB, Fleming RA, Shen P, et al. Long-term survivorship and quality of life after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol. 2003;10(2):155–62.CrossRefPubMed

36.

McQuellon RP, Russell GB, Shen P, Stewart JHt, Saunders W, Levine EA. Survival and health outcomes after cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of appendiceal origin. Ann Surg Oncol. 2008;15(1):125–33.CrossRefPubMed

Title: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study
Authors: Mohammad Alyami, MD
Peter Lundberg, MD
Vahan Kepenekian, MD
Diane Goéré, MD, PhD
Jean-Marc Bereder, MD, PhD
Simon Msika, MD, PhD
Gérard Lorimier, MD
François Quenet, MD
Gwenaël Ferron, MD
Emilie Thibaudeau, MD
Karine Abboud, MD
Réa Lo Dico, MD
Delphine Delroeux, MD
Cécile Brigand, MD, PhD
Catherine Arvieux, MD, PhD
Frédéric Marchal, MD, PhD
Jean-Jacques Tuech, MD, PhD
Jean-Marc Guilloit, MD
Frédéric Guyon, MD
Patrice Peyrat, MD
Denis Pezet, MD, PhD
Pablo Ortega-Deballon, MD, PhD
Franck Zinzindohoue, MD, PhD
Cécile de Chaisemartin, MD
Reza Kianmanesh, MD
Olivier Glehen, MD, PhD
Guillaume Passot, MD, PhD
on behalf of the BIG-RENAPE and RENAPE Working Groups
Publication date: 01-12-2016
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue Special Issue 5/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-016-5519-2

At a glance: The STEP trials

Springer Medicine

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study

Abstract

Objective

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Background

Methods

Results

Conclusions

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