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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Elderly Patients: Complete Cytoreduction Is Feasible and Crucial for Improved Survival Despite High Carcinomatosis Index.

Abstract We aimed to study the surgical outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in elderly patients, and investigate whether the pursuit of complete cytoreduction implies a survival benefit despite a high peritoneal carcinomatosis index (PCI).
PMID
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Authors

Mayor MeshTerms
Keywords

CRS

Cytoreductive surgery

HIPEC

elderly

survival

Journal Title anticancer research
Publication Year Start




PMID- 29277807
OWN - NLM
STAT- In-Process
LR  - 20171226
IS  - 1791-7530 (Electronic)
IS  - 0250-7005 (Linking)
VI  - 38
IP  - 1
DP  - 2018 Jan
TI  - Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Elderly
      Patients: Complete Cytoreduction Is Feasible and Crucial for Improved Survival
      Despite High Carcinomatosis Index.
PG  - 441-448
AB  - BACKGROUND: We aimed to study the surgical outcomes of cytoreductive surgery
      (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in elderly patients, 
      and investigate whether the pursuit of complete cytoreduction implies a survival 
      benefit despite a high peritoneal carcinomatosis index (PCI). PATIENTS AND
      METHODS: All CRS and HIPEC procedures performed for patients with peritoneal
      surface malignancy (PSM) >/=65 years old between 2005-2017 were included. A
      control group comprising patients 60-64 years old who underwent CRS and HIPEC
      over the same period was also selected for comparison of characteristics and
      outcomes. RESULTS: A total of 54 elderly patients and 27 control patients were
      included. Increasing age did not result in any difference in demographics,
      perioperative characteristics, or surgical outcomes. Elderly patients who
      achieved completeness of cytoreduction (CC) 0/1 were compared to those with
      CC2/3, and were found to have a higher body mass index, lower peritoneal cancer
      index, higher rate of inpatient mortality, and a significantly longer median
      survival (43 vs. 15 months; p=0.020). Cox multivariate regression identified
      Charlson score >/=2, the occurrence of major morbidities, colorectal and sarcoma 
      primary tumor, and CC2/3 as significant predictors of poor survival. CONCLUSION: 
      CRS and HIPEC are feasible in elderly patients without a significant effect of
      increasing age on the surgical outcomes. CC0/1 carries higher postoperative
      mortality rate, but yields a longer overall survival. Baseline comorbidities,
      postoperative complications, certain histologies, and CC2/3 are predictors of
      poor prognosis in this population. PCI is a predictor of CC, but not of survival 
      when CC0/1 is achieved.
CI  - Copyright(c) 2018, International Institute of Anticancer Research (Dr. George J. 
      Delinasios), All rights reserved.
FAU - Naffouje, Samer A
AU  - Naffouje SA
AD  - Department of General Surgery, University of Illinois at Chicago Hospital and
      Health Sciences System, Chicago, IL, U.S.A. [email protected]
FAU - Salti, George I
AU  - Salti GI
AD  - Department of Surgical Oncology, Edward Cancer Center, Naperville, IL, U.S.A.
AD  - Division of Surgical Oncology, University of Illinois at Chicago Hospital and
      Health Sciences System, Chicago, IL, U.S.A.
LA  - eng
PT  - Journal Article
PL  - Greece
TA  - Anticancer Res
JT  - Anticancer research
JID - 8102988
OTO - NOTNLM
OT  - CRS
OT  - Cytoreductive surgery
OT  - HIPEC
OT  - elderly
OT  - survival
EDAT- 2017/12/27 06:00
MHDA- 2017/12/27 06:00
CRDT- 2017/12/27 06:00
PHST- 2017/09/17 00:00 [received]
PHST- 2017/10/24 00:00 [revised]
PHST- 2017/10/31 00:00 [accepted]
PHST- 2017/12/27 06:00 [entrez]
PHST- 2017/12/27 06:00 [pubmed]
PHST- 2017/12/27 06:00 [medline]
AID - 38/1/441 [pii]
PST - ppublish
SO  - Anticancer Res. 2018 Jan;38(1):441-448.