Morbidity and mortality outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients aged 75 years and over: Spanish group of peritoneal cancer surgery (GECOP) multicenter study

Abstract

Background: The aim of this study is to report the perioperative outcomes of cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in patients 75 years from a Spanish multi-institutional experience. Methods: This multi-institutional retrospectively analyzed a prospectively collected clinical data from 10 Spanish hospitals that are part of the Spanish Group Peritoneal Cancer Surgery (GECOP). We assessed postoperative morbidity rates and performed univariate and multivariate analyses of factors associated with overall (grade IeIV) and major (grade IIIeIV) postoperative morbidity. Results: A total of 85 patients aged 75 years were included. Forty six postoperative adverse events were detected in 37 patients (43.5%). Twenty five complications in 20 patients (23.5%) were mild (grade IeII) and 16 complications in 12 patients (14.1%) were moderate-severe (grade IIIeIV). Five patients died in the first 90 days after the procedure (5.9%). After multivariate analysis, independent factors associated with postoperative complications were: PCI> 12 (OR: 4.14, 95% CI 1.22e14.12, p ¼ 0.043) and the need for perioperative blood transfusion (OR: 14.91, 95% CI 3.87e57.46, p < 0.001). Regarding grade IIIeIV complications, after multivariate analysis, the presence of preoperative albumin levels <3.5 mgr/dl (OR:9.15, 95% CI 1.38e60.57, p ¼ 0.017), need for diaphragmatic peritonectomy procedures (OR: 11.32, 95% CI1.40e91.32, p ¼ 0.023) and perioperative blood transfusion (OR: 8.58, 95% CI 1.44e51.16, p ¼ 0.018) were independent factors. Conclusions: Cytoreductive surgery and performing HIPEC by experienced groups in selected patients aged 75 years can be performed with morbidity and mortality similar to that described in the literature.