Received: 11 February 2017 Accepted: 15 May 2017 Published on: 11 July 2017
Morbidity and mortality of elderly patients following
cytoreductive surgery and Hyperthermic Intraperitoneal
Evelyn Y.T. Wong Grace H.C. Tan Claramae S.L. Chia Mrinal Kumar
Khee Chee Soo Melissa C.C. Teo
Division of Surgical Oncology, National
Cancer Center Singapore, Singapore,
Republic of Singapore
A/Prof MelissaChing Ching Teo, Division of
Surgical Oncology, National Cancer Centre
Singapore, 11 Hospital Drive, Singapore 169610,
Republic of Singapore.
Aim: Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is
known to improve survival in selected patients with peritoneal metastasis. However, there is lim-
ited data supporting the role of CRS and HIPEC in elderly patients (≥65 years old).
Methods: A retrospective review of a prospectively maintained database of patients who under-
went CRS-HIPEC between April 2001 and July 2015 from a single institution was performed.
Patients were divided into two groups non-elderly (<65 years old), and elderly (≥65 years old).
Clinico- pathological parameters, morbidity and overall (OS) and disease-free survival (DFS) of the
patients were compared.
Results: A total of 177 patients (median age 52, range 9–74) underwent CRS-HIPEC with curative
intent. There were 159 non-elderly patients and 18 elderly patients. Median PCI scores were 12
(0–39) for the non- elderly patients and 11 (1–29) for the elderly patients (p=0.77). High-grade
complications occurred in 39 non-elderly patients (24.5%) and 8 elderly patients (44.4%) (p=0.79),
while 58 non-elderly patients (38.7%) and 7 elderly patients (41.2%) stayed in ICU for more than 1
day (p=0.69). There was no difference in the 30-day mortality between the two groups (0% vs. 0%,
p=1). After a median follow-up of 16 months for all patients, there was no difference in 5-years OS
(51.0% vs. 59.6%, p=0.88) and 5-years DFS (23.3% vs. 53.3%, p=0.60) between non-elderly and
Conclusions: Surgical outcomes after CRS-HIPEC do not differ signiﬁcantly between non-elderly
and elderly patients. Hence, age should not be a contraindication in selecting patients for CRS and
elderly, HIPEC, surgical oncology
Cytoreductive surgery (CRS), along with hyperthermic intraperitoneal
chemotherapy (HIPEC) has been gaining acceptance as the treatment
of choice for selected patients with peritoneal metastases (PM) from
gastrointestinal, ovarian and peritoneal origins.
In a prospective
study of 460 patients with PM from gastrointestinal malignancy, who
underwent 501 (CRS-HIPEC) procedures,
the median survival was
found to be 22.2 months with a 5-year survival rate up to 27.8%. This
exceeds the median survival of approximately 6 months for patients
with PM who are treated with systemic chemotherapy or conservative
management with a palliative intent.
With higher life expectancy in an increasingly aging population, we
can expect an increasing number of elderly patients, i.e. aged 65 and
above as well. However, physicians may be less likely to consider CRS
and HIPEC for elderly patients because of the presumed higher mor-
bidity associated with age. There have been studies looking at the mor-
bidity and mortality associated with CRS and HIPEC, but none are
focused on elderly patients, with limited literature on CRS and HIPEC
in the elderly population.
Using prospectively collected data from a tertiary institution, we
examined the outcomes of elderly patients who underwent CRS and
HIPEC for PM from ovarian, colorectal and other gastrointestinal can-
cers, as well as primary peritoneal disease. In our study, patients were
Asia-Pac J Clin Oncol. 2018;14:e193–e202.
2017 John Wiley & Sons Australia, Ltd e193wileyonlinelibrary.com/journal/ajco