Available online 14 September 2022, 101848

We retrospectively analyzed two institutions databases of patients with peritoneal metastases of colorectal cancer origin (PM-CRC) for the short and long term outcomes of elderly patients (>70 ys.).

Cytoreductive Surgery and Hyperthermic intra peritoneal chemotherapy (CRS + HIPEC) can be safely used in elderly patients with PM-CRC with a low-range PCI.

Although tumor extent and surgical radicality were comparable in the elderly and the non-elderly patients, long term outcomes were inferior in the elderly.

We attribute this effect to the low use of adjuvant chemotherapy in the elderly.

CRS + HIPEC should be viewed as single, albeit important, component of PM-CRC multi-modal treatment.

Systemic chemotherapy should be considered as a continuum to optimal surgical treatment even in the elderly.

Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) were reportedly safe for the elderly. However, long-term survival data in this subgroup of patients are scarce. Our aim was to evaluate the peri-operative and long-term outcomes of CRS + HIPEC in colorectal peritoneal metastases (CRC-PM) in patients ≥70 years of age.

We retrospectively analyzed our combined institutional databases for patients who underwent CRS + HIPEC for CRC-PM. Clinical and pathological characteristics, as well as overall survival (OS) and progression-free survival (PFS) were compared between the groups. Tumor extent was measured by the peritoneal carcinomatosis index (PCI) and completeness of cytoreduction by the CCR score. Major morbidity was defined according to Clavien-Dindo classification.

The dataset of 159 patients included 33 elderly and 126 non-elderly patients. Clinical characteristics between the groups differed only in medical comorbidities (Charlson comorbidity index 10 vs. 7, P < 0.001) and delivery of post-HIPEC adjuvant treatment (12.5% vs. 43.8%, P = 0.004). Overall PCI and CCR0 rates were similar between the groups, as were length of stay and major morbidity and mortality rates. Long-term outcomes in the elderly group were lower than those of the non-elderly (median OS: 21.8 vs. 40.5 months, P < 0.001; median PFS: 6 vs. 8 months, P = 0.02, respectively).

CRS + HIPEC in selected elderly patients can be safe in terms of postoperative morbidity and mortality. However, despite the same surgical extents and radicality, their long-term outcomes are inferior, possibly due to under-usage of systemic chemotherapy.

Peritoneal colorectal metastases

Cytoreductive surgery and heated intraperitoneal chemotherapy

Elderly

Long-term outcomes

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