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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for the Elderly: Is It Reasonable? A Meta-Analysis

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Whether cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is safe and worthwhile for elderly patients remains unclear. This meta-analysis of outcomes after CRS plus HIPEC for the elderly aimed to generate a higher level of evidence and precise indications for these patients.

Methods

A systematic literature search for studies reporting postoperative outcomes after CRS plus HIPEC for elderly patients was performed in the MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Web of Knowledge Conference Proceedings Citation Index-Science, and Google Scholar databases. The included studies evaluated the overall 30-day postoperative morbidity, 90-day postoperative mortality, grade 3 or higher postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay.

Results

The inclusion criteria were met by 13 retrospective studies involving 2544 patients. Considering only comparative studies, the 90-day postoperative mortality was significantly increased for elderly patients [odds ratio (OR), 0.49; 95% confidence interval (CI), 0.27–0.88; I 2 = 79%]. The 30-day grade 3 or higher postoperative morbidity was increased in the patients 70 years of age or older (14.5%; 95% CI 8.1–24.4 vs. 32.3%; 95% CI 22.4–44.0%; p = 0.004; I 2 = 85%). The overall 30-day postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay were not affected by age.

Conclusions

Treatment of the elderly with CRS plus HIPEC was associated with increased severe postoperative morbidity and mortality. However, these conclusions should be weighted given the existence of major biases in the included studies. Age alone probably would not be a formal contraindication, but frailty should be taken into account. Further prospective studies are needed.

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Disclosures

No conflicts of interest or funding to disclose for this study.

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Authors and Affiliations

  1. Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France

    Johan Gagnière MD, PhD, Julie Veziant MD, Denis Pezet MD, PhD, Bertrand Le Roy MD & Karem Slim MD

  2. U1071 INSERM, Université Clermont-Auvergne, Clermont-Ferrand, France

    Johan Gagnière MD, PhD, Julie Veziant MD & Denis Pezet MD, PhD

  3. Biostatistics, Délégation à la Recherche Clinique et à l’Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France

    Bruno Pereira PhD

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  1. Johan Gagnière MD, PhD
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Correspondence to Johan Gagnière MD, PhD.

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Supplementary material 1 (DOCX 38 kb)

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Supplementary material 2 (TIFF 59 kb) Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart of the literature search

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Gagnière, J., Veziant, J., Pereira, B. et al. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for the Elderly: Is It Reasonable? A Meta-Analysis. Ann Surg Oncol 25, 709–719 (2018). https://doi.org/10.1245/s10434-017-6313-5

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  • DOI: https://doi.org/10.1245/s10434-017-6313-5

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