Cytoreductive surgery in the elderly patients--is it feasible?

Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (HIPEC) is an aggressive treatment for patients with peritoneal malignancies. While promising, this therapeutic approach is still associated with significant morbidity and mortality. Surgical risk in elderly patients is even higher, since these people suffer from frequent comorbidities, resulting in poorer performance status. Whether this type of major cancer surgery is feasible in elderly patients is an ongoing question.

Retrospective analysis of elderly patients, undergoing cytoreductive surgery during a period of three years in one centre. Criteria of patients' eligibility were peritoneal carcinomatosis of different origin, age > 65 years, good general status, no extra-abdominal extension and no evidence of bowel obstruction. To reduce morbidity of surgical procedure special perioperative management program including intensified warming management, intra-operative fluid restriction, control of hyperglycaemia, increase of the tissue oxygenation, restriction of blood loss and adenosine receptor activation was employed.

Between January 2004 and January 2007, 47 cytoreductive interventions have been carried out in 44 patients aged older than 65 years at the Department for Surgical Oncology KKH Hammelburg. Mean age of patients in this group was 71 years (min. 65 years, max 82 years). Mean duration of surgery was 5.3 hours (SD = 1.59; range 3.0 to 8.5 hours). Mean duration of the hospital stay was 19.3 days (SD = 9.55, range 11 to 58 days). The frequency of grade 3 and 4 complications was 17.0%. There was no postoperative death registered within the 30 days after surgery (30-days mortality rate 0%).

Incorporating new strategies to reduce morbidity makes aggressive cytoreduction procedure feasible in the majority of elderly patients. Age and advanced peritoneal malignancy should not preclude patients from the maximal surgical effort.