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Morbidity and Mortality of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients Aged 70
Ali Ediz Kıvanç1, Mehmet Oduncu2, Pırıltı Özcan3
1Department of General Surgery, Yeditepe University Faculty of Medicine, Istanbul, Turkey.
Background And Objectives:
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is established for peritoneal surface malignancies, but its use in older patients is debated. We assessed CRS-HIPEC morbidity and mortality in patients aged ≥ 70 years using a cohort of younger patients as a comparator.
Methods:
We retrospectively reviewed consecutive patients aged ≥ 70 and < 70 undergoing CRS-HIPEC for peritoneal carcinomatosis at two centers (2017-2026). Peritoneal carcinomatosis index (PCI), completeness of cytoreduction (CC), complications (Clavien-Dindo), and mortality were analyzed.
Results:
Ninety-five patients were included (53 female; mean age 74.7 years; 10 [10.5%] aged ≥ 80; 70 [73.7%] ASA III-IV). Commonest primaries: colorectal (40), gastric (14), ovarian (12). Mean PCI was 15.6; complete cytoreduction (CC-0) was achieved in 58.9%. Complications were Clavien-Dindo grade III-IV in 11.6%, and grade V in 3.2%; major morbidity (≥ III) was 14.7%. Longer operative time (p = 0.013) and intraoperative transfusion (p = 0.027) were associated with major morbidity in the elderly cohort, whereas age was not (p = 0.161). Overall mortality was 12/95 (12.6%).
Conclusions:
In selected patients aged ≥ 70 years, CRS-HIPEC achieved morbidity and mortality comparable to the younger group, with most complications low-grade. Advanced age alone should not preclude CRS-HIPEC; candidacy depends on comorbidity, performance status, and the likelihood of complete cytoreduction.
