Michael K Turgeon1, Adriana C Gamboa1, Rachel M Lee1, Mohammad Y Zaidi1, Charles Kimbrough2, Travis Grotz3, Keith Fournier4, Benjamin Powers5,6, Sean Dineen5,6, Jula Veerapong7, Callisia Clarke8, Harveshp Mogal8, Sameer H Patel9, Laura Lambert10, Sean Ronnekleiv-Kelly11, Mustafa Raoof12, Nadege Fackche13, Jonathan B Greer13, Charles A Staley1, Jordan M Cloyd2, Shishir K Maithel1, Joshua H Winer14. 1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 2. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 3. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA. 4. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA. 6. Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA. 7. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA. 8. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 9. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 10. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA. 11. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA. 12. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA. 13. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. 14. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. jhwiner@emory.edu.
Abstract
BACKGROUND: Patient age is a significant factor in preoperative selection for major abdominal surgery. The association of age, tumor biology, and postoperative outcomes in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains ill-defined. METHODS: Retrospective analysis was performed for patients who underwent a CCR0/1 CRS/HIPEC from the US HIPEC Collaborative Database (2000-2017). Age was categorized into < 65 or ≥ 65 years. Primary outcome was postoperative major complications. Secondary outcomes were non-home discharge (NHD) and readmission. Analysis was stratified by disease histology: non-invasive (appendiceal LAMN/HAMN), and invasive (appendiceal/colorectal adenocarcinoma). RESULTS: Of 1090 patients identified, 22% were ≥ 65 (n = 240), 59% were female (n = 646), 25% had non-invasive (n = 276) and 51% had invasive (n = 555) histology. Median PCI was 13 (IQR 7-20). Patients ≥ 65 had a higher rate of major complications (37 vs 26%, p = 0.02), NHD (12 vs 5%, p < 0.01), and readmission (28 vs 22%, p = 0.05), compared to those < 65. For non-invasive histology, age ≥ 65 was not associated with major complications or NHD on multivariable analysis. For invasive histology, when accounting for PCI and CCR, age ≥ 65 was associated with major complications (OR 2.04, 95% CI 1.16-3.59, p = 0.01). When accounting for major complications, age ≥ 65 was associated with NHD (OR 2.54, 95% CI 1.08-5.98, p = 0.03). Age ≥ 65 was not predictive of readmission for any histology when accounting for major complications. CONCLUSIONS: Age ≥ 65 years is an independent predictor for postoperative major complications and non-home discharge for invasive histology, but not non-invasive histology. These data inform preoperative counseling, risk stratification, and early discharge planning.
BACKGROUND:Patient age is a significant factor in preoperative selection for major abdominal surgery. The association of age, tumor biology, and postoperative outcomes in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains ill-defined. METHODS: Retrospective analysis was performed for patients who underwent a CCR0/1 CRS/HIPEC from the US HIPEC Collaborative Database (2000-2017). Age was categorized into < 65 or ≥ 65 years. Primary outcome was postoperative major complications. Secondary outcomes were non-home discharge (NHD) and readmission. Analysis was stratified by disease histology: non-invasive (appendiceal LAMN/HAMN), and invasive (appendiceal/colorectal adenocarcinoma). RESULTS: Of 1090 patients identified, 22% were ≥ 65 (n = 240), 59% were female (n = 646), 25% had non-invasive (n = 276) and 51% had invasive (n = 555) histology. Median PCI was 13 (IQR 7-20). Patients ≥ 65 had a higher rate of major complications (37 vs 26%, p = 0.02), NHD (12 vs 5%, p < 0.01), and readmission (28 vs 22%, p = 0.05), compared to those < 65. For non-invasive histology, age ≥ 65 was not associated with major complications or NHD on multivariable analysis. For invasive histology, when accounting for PCI and CCR, age ≥ 65 was associated with major complications (OR 2.04, 95% CI 1.16-3.59, p = 0.01). When accounting for major complications, age ≥ 65 was associated with NHD (OR 2.54, 95% CI 1.08-5.98, p = 0.03). Age ≥ 65 was not predictive of readmission for any histology when accounting for major complications. CONCLUSIONS: Age ≥ 65 years is an independent predictor for postoperative major complications and non-home discharge for invasive histology, but not non-invasive histology. These data inform preoperative counseling, risk stratification, and early discharge planning.
Authors: M Leimkühler; A R Bourgonje; H van Goor; M J E Campmans-Kuijpers; G H de Bock; B L van Leeuwen Journal: Ann Surg Oncol Date: 2022-02-17 Impact factor: 4.339
Authors: Caroline J Rieser; Heather Jones; Lauren B Hall; Eliza Kang; Shannon Altpeter; Amer H Zureikat; Matthew P Holtzman; Andrew Lee; Melanie Ongchin; James F Pingpank; M Haroon A Choudry; David L Bartlett Journal: Ann Surg Oncol Date: 2021-07-05 Impact factor: 5.344