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BMC Geriatrics

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Volume 10 Supplement 1

de Senectute: Age and Health Forum

Open Access

The treatment of peritoneal carcinomatosis in elderly patients

  • A Macrì1,
  • E Saladino1,
  • V Adamo2,
  • G Altavilla2,
  • G Condemi3,
  • E Mondello4,
  • A Sinardi4,
  • S Irato5 and
  • C Famulari1
BMC Geriatrics201010(Suppl 1):A11

https://doi.org/10.1186/1471-2318-10-S1-A11

Published: 19 May 2010

Background

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

For this study we have only considered the patients with a minimal follow up of 18 months. For this reason we have evaluated 30 patients, 11 (36,6%) aged > 65 years, submitted, in the period May 2004 –April 2008, to 33 CRS plus HIPEC. Criteria of patients' eligibility were peritoneal carcinomatosis of different origins, T3-4 gastric cancer, ECOG performance status ≤2, no extra-abdominal extension and no evidence of bowel obstruction. For the intraoperative staging we have used the “Peritoneal Cancer Index” (PCI) [1] and to evaluate the entity of cytoreduction the “Completeness of Cytoreduction score” (CC score) [2] (Figure 1).
Figure 1

Peritoneal Cancer Index and Completeness of Cytoreduction score

Results

Results of our experience are reported in Table 1.
Table 1

characteristics of patients and results

 

Pts

Procedures

Mean age

(range)

Chronic comorbidities

Mean duration of surgery (min.)

Mean PCI

CC score

Mean postop. hospital stay (days)

Morbidity

Mortality

18 mths overall surv.

Total

30

33

58,3

(30-77)

18/30 (60%)

556,7

8,2

29 pts: 0

3pts:1

1 pt. with relapse: 2

17

21,2%

9%

66,6%

Pts aged < 65 years

19

22

52,7

(30-63)

7/19 (36,8%)

551,3

8,1

19 pts: 0

2 pts: 1

1 pt. with relapse: 2

17,2

18,1%

4,5%

68,4%

Pts aged > 65 years

11

11

69,7

(66-77)

11/11 (100%)

567,5

8,2

10 pts: 0

1 pt: 1

15,6

27,2%

18,1%

63,6%

Conclusions

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 [3]. 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 [3], that age and advanced peritoneal malignancy should not preclude patients from the maximal surgical effort.

Authors’ Affiliations

(1)
University of Messina, General Surgery Unit
(2)
University of Messina, Medical Oncology Unit
(3)
Ospedali Riuniti della Locride, Hospital of Siderno, Medical Oncology Unit
(4)
University of Messina, Anesthesiology Unit
(5)
University of Messina, Gynecologic Oncology Unit

References

  1. Berthet B, Sugarbaker TA, Chang D, Sugarbaker PH: Quantitative methodologies for selection of patients with recurrent abdominopelvic sarcoma for treatment. Eur J Cancer. 1999, 35 (3): 413-9. 10.1016/S0959-8049(98)00375-X.PubMedView ArticleGoogle Scholar
  2. Sugarbaker PH: Current Indications for Cytoreductive Surgery and Intraperitoneal Chemotherapy. Management of peritoneal surface malignancy using intraperitoneal chemotherapy and cytoreductive surgery. 1998, The Ludann Company Grand Rapids eds., Michigan., 18:Google Scholar
  3. Mueller H, Hahn M, Simsa J: Cytoreductive surgery in the elderly patients--is it feasible?. Hepatogastroenterology. 2008, 55 (88): 2005-11.PubMedGoogle Scholar

Copyright

© Macrì et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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