The treatment of peritoneal carcinomatosis in elderly patients
© Macrì et al; licensee BioMed Central Ltd. 2010
Published: 19 May 2010
Peritoneal carcinomatosis is a frequent evolution of gastrointestinal and gynecologic malignancy and it has been regarded as a lethal clinical entity. Treatment options for these patients have improved significantly in the past few years. CytoReductive Surgery (CRS) plus Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) is an aggressive and promising treatment for patients with peritoneal malignancies. Whether this type of major cancer surgery is feasible in elderly patients is an ongoing question.
Materials and methods
characteristics of patients and results
Mean duration of surgery (min.)
Mean postop. hospital stay (days)
18 mths overall surv.
29 pts: 0
1 pt. with relapse: 2
Pts aged < 65 years
19 pts: 0
2 pts: 1
1 pt. with relapse: 2
Pts aged > 65 years
10 pts: 0
1 pt: 1
The rationale of CRS plus HIPEC is based respectively on the removal of gross disease and on the eradication of microscopic residual disease. The peritoneal-plasma barrier retards the clearance of high molecular weight chemotherapy from the peritoneal cavity and allows a large exposure of small residual cancer nodules. Tissue penetration of the intraperitoneal chemotherapy is facilitated by moderate hyperthermia (41-42ºC). This promising therapeutic approach is associated with significant morbidity and mortality and the surgical risk in elderly patients is even higher, since these people suffer from frequent comorbidities . In our experience we have recorded, in elderly patients, higher, but acceptable, morbidity (27,2% vs 18,1%) and mortality (18,1% vs 4,5%), probably correlated with their comorbidities (100% vs 36,8%), lower mean postoperative hospital stay (15,6 days vs 17,2) and a good 18-months overall survival (63,6%). We retain, on the basis of our experience and of the data of the literature , that age and advanced peritoneal malignancy should not preclude patients from the maximal surgical effort.
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