Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis in the elderly: A case-controlled, multicenter study
Mohammad Alyami
(1)
,
Peter Lundberg
(1)
,
Vahan Kepenekian
(1)
,
Diane Goere
(2)
,
Jean-Marc Bereder
(3)
,
Simon Msika
(4)
,
Gérard Lorimier
(5)
,
François Quenet
(6, 7)
,
Gwenaël Ferron
(8)
,
Emilie Thibaudeau
(9)
,
Karine Abboud
(10)
,
Réa Lo Dico
(11)
,
Delphine Delroeux
(12)
,
Cécile Brigand
(13)
,
Catherine Arvieux
(14)
,
Frédéric Marchal
(15, 16)
,
Jean-Jacques Tuech
(17)
,
Jean-Marc Guilloit
(18)
,
Frédéric Guyon
(19)
,
Patrice Peyrat
(20)
,
Denis Pezet
(21)
,
Pablo Ortega-Deballon
(22)
,
Franck Zinzindohoué
(23)
,
Cécile de Chaisemartin
(24)
,
Reza Kianmanesh
(25)
,
Olivier Glehen
(1, 26)
,
Guillaume Passot
(1, 26)
,
Big-Renape Group
,
Renape Group
1
Service d'Oncologie Médicale [Centre hospitalier Lyon Sud - HCL]
2 Département de chirurgie générale [Gustave Roussy]
3 CHU Nice - Centre Hospitalier Universitaire de Nice
4 Hôpital Louis Mourier - AP-HP [Colombes]
5 CHU Angers - Centre Hospitalier Universitaire d'Angers
6 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
7 Département de chirurgie
8 Institut Claudius Regaud
9 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
10 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
11 Service de Chirurgie d'Oncologie Digestive [CHU Lariboisière]
12 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
13 Hôpital de Hautepierre [Strasbourg]
14 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
15 CRAN - Centre de Recherche en Automatique de Nancy
16 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
17 Service de Chirurgie Digestive [CHU Rouen]
18 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
19 Département de chirurgie
20 Centre Léon Bérard [Lyon]
21 CHU Clermont-Ferrand
22 Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon)
23 Service de chirurgie digestive, générale et cancérologique [CHU HEGP]
24 IPC - Institut Paoli-Calmettes
25 Hôpital universitaire Robert Debré [Reims]
26 EA3738 - Ciblage thérapeutique en Oncologie
2 Département de chirurgie générale [Gustave Roussy]
3 CHU Nice - Centre Hospitalier Universitaire de Nice
4 Hôpital Louis Mourier - AP-HP [Colombes]
5 CHU Angers - Centre Hospitalier Universitaire d'Angers
6 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
7 Département de chirurgie
8 Institut Claudius Regaud
9 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
10 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
11 Service de Chirurgie d'Oncologie Digestive [CHU Lariboisière]
12 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
13 Hôpital de Hautepierre [Strasbourg]
14 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
15 CRAN - Centre de Recherche en Automatique de Nancy
16 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
17 Service de Chirurgie Digestive [CHU Rouen]
18 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
19 Département de chirurgie
20 Centre Léon Bérard [Lyon]
21 CHU Clermont-Ferrand
22 Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon)
23 Service de chirurgie digestive, générale et cancérologique [CHU HEGP]
24 IPC - Institut Paoli-Calmettes
25 Hôpital universitaire Robert Debré [Reims]
26 EA3738 - Ciblage thérapeutique en Oncologie
Peter Lundberg
- Fonction : Auteur
- PersonId : 905179
Gwenaël Ferron
- Fonction : Auteur
- PersonId : 802487
- ORCID : 0000-0002-8545-4700
Pablo Ortega-Deballon
- Fonction : Auteur
- PersonId : 867260
Big-Renape Group
- Fonction : Auteur
Renape Group
- Fonction : Auteur
Résumé
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.