Faculty Collaboration Database

The Intersection of Age and Tumor Biology with Postoperative Outcomes in Patients After Cytoreductive Surgery and HIPEC. Ann Surg Oncol 2020 Dec;27(13):4894-4907

Date

05/08/2020

Pubmed ID

32378087

Pubmed Central ID

PMC7644621

DOI

10.1245/s10434-020-08538-y

Scopus ID

2-s2.0-85085094642 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

BACKGROUND: Patient age is a significant factor in preoperative selection for major abdominal surgery. The association of age, tumor biology, and postoperative outcomes in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains ill-defined.

METHODS: Retrospective analysis was performed for patients who underwent a CCR0/1 CRS/HIPEC from the US HIPEC Collaborative Database (2000-2017). Age was categorized into < 65 or ≥ 65 years. Primary outcome was postoperative major complications. Secondary outcomes were non-home discharge (NHD) and readmission. Analysis was stratified by disease histology: non-invasive (appendiceal LAMN/HAMN), and invasive (appendiceal/colorectal adenocarcinoma).

RESULTS: Of 1090 patients identified, 22% were ≥ 65 (n = 240), 59% were female (n = 646), 25% had non-invasive (n = 276) and 51% had invasive (n = 555) histology. Median PCI was 13 (IQR 7-20). Patients ≥ 65 had a higher rate of major complications (37 vs 26%, p = 0.02), NHD (12 vs 5%, p < 0.01), and readmission (28 vs 22%, p = 0.05), compared to those < 65. For non-invasive histology, age ≥ 65 was not associated with major complications or NHD on multivariable analysis. For invasive histology, when accounting for PCI and CCR, age ≥ 65 was associated with major complications (OR 2.04, 95% CI 1.16-3.59, p = 0.01). When accounting for major complications, age ≥ 65 was associated with NHD (OR 2.54, 95% CI 1.08-5.98, p = 0.03). Age ≥ 65 was not predictive of readmission for any histology when accounting for major complications.

CONCLUSIONS: Age ≥ 65 years is an independent predictor for postoperative major complications and non-home discharge for invasive histology, but not non-invasive histology. These data inform preoperative counseling, risk stratification, and early discharge planning.

Author List

Turgeon MK, Gamboa AC, Lee RM, Zaidi MY, Kimbrough C, Grotz T, Fournier K, Powers B, Dineen S, Veerapong J, Clarke C, Mogal H, Patel SH, Lambert L, Ronnekleiv-Kelly S, Raoof M, Fackche N, Greer JB, Staley CA, Cloyd JM, Maithel SK, Winer JH

Author

Callisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Biology
Cytoreduction Surgical Procedures
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention
Peritoneal Neoplasms
Postoperative Complications
Retrospective Studies