Can Elderly Patients with Peritoneal Metastasis Induced by Appendiceal or Colorectal Tumours Benefit from Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?

Figures & data

Table 1 Clinicopathological Characteristics of 100 Patients Underwent CRS/HIPEC

Characteristics	Overall (n = 100)	Age ≥ 65 Years (n = 25)	Age < 65 Years (n = 75)	P
Age, year (mean±SD)	56.5 ± 11.5	68.9 ± 3.5	50.6 ± 9.6	<0.001
Gender				0.908
Male	53 (53.0)	13 (52.0)	40 (53.3)
Female	47 (47.0)	12 (48.0)	35 (46.7)
BMI, kg/m^2 (mean±SD)	23.0 ± 2.7	23.5 ± 2.5	22.7 ± 2.8	0.376
ASA score				0.039
I	38 (38.0)	6 (24.0)	32 (42.7)
II	58 (58.0)	16 (64.0)	42 (56.0)
III	4 (4.0)	3 (12.0)	1 (1.3)
Cardio-pulmonary comorbidities				0.002
Presence	28 (28.0)	13 (52.0)	15 (20.0)
Absence	72 (72.0)	12 (48.0)	60 (80.0)
Presentation of PM				0.193
Synchronous	61 (61.0)	18 (72.0)	43 (57.3)
Metachronous	39 (39.0)	7 (28.0)	32 (42.7)
Primary tumour				0.836
Colon	63 (63.0)	17 (68.0)	46 (61.3)
Rectum	23 (26.0)	5 (25.0)	18 (24.0)
Appendix	14 (14.0)	3 (12.0)	11 (14.7)
Preoperative CEA level, ng/mL (mean±SD)	30.1 ± 61.8	31.5 ± 76.9	29.7 ± 59.3	0.927
Preoperative CA19-9 level, ng/mL (mean±SD)	63.4 ± 84.0	68.4 ± 105.2	56.4 ± 65.9	0.655
Histology				0.465
Adenocarcinoma	66 (66.0)	15 (60.0)	51 (68.0)
Mucinous/signet-ring	34 (34.0)	10 (40.0)	24 (32.0)
PCI sorce (mean±SD)	11.0 ± 5.8	10.6 ± 5.0	11.2 ± 6.1	0.673
Liver metastases				0.506
Presence	14 (14.0)	5 (25.0)	9 (12.0)
Absence	86 (86.0)	20 (75.0)	66 (88.0)
Ascites				0.557
Presence	41 (41.0)	9 (36.0)	32 (42.7)
Absence	59 (59.0)	16 (64.0)	43 (57.3)
CC score				0.901
CC 0–1	69 (69.0)	17 (68.0)	52 (69.3)
CC 2–3	31 (31.0)	8 (32.0)	23 (20.7)

Abbreviations: BMI, body mass index; ASA, American Society of Anesthesiologists; PM, peritoneal metastasis; PCI, peritoneal carcinomatosis index; CC score, cytoreduction score.

Table 2 Perioperative Data of 100 Patients Underwent CRS/HIPEC

Characteristics	Overall (n = 100)	Age ≥ 65 Years (n = 25)	Age < 65 Years (n = 75)	P
Operation method				1.000
Laparoscopic surgery	18 (18.0)	4 (16.0)	14 (18.7)
Open surgery	82 (82.0)	21 (84.0)	61 (81.3)
HIPEC regimen				0.204
Lobaplatin+Oxaliplatin+Raltitrexed	48 (48.0)	10 (40.0)	41 (54.7)
Oxaliplatin+Raltitrexed	52 (52.0)	15 (60.0)	34 (45.3)
Operative time, min (mean±SD)	240.6 ± 69.5	235.6 ± 66.5	254.3 ± 70.8	0.237
Estimated blood loss, mL (mean±SD)	124.0 ± 113.5	127.6 ± 122.0	122.8 ± 112.1	0.857
Postoperative complications	43 (43.0)	14 (56.0)	29 (38.7)	0.130
Postoperative complications (grades III, IV)	22 (22.0)	7 (28.0)	15 (20.0)	0.403
Arrhythmia	1 (1.0)	1 (4.0)	0 (0)	0.250
Pneumonia	2 (2.0)	1 (4.0)	1 (1.3)	0.439
Pleural effusion	2 (2.0)	1 (4.0)	1 (1.3)	0.439
Anastomotic leakage	3 (3.0)	1 (4.0)	2 (2.6)	1.000
Ileus	6 (6.0)	4 (16.0)	2 (2.6)	0.033
Gastrointestinal hemorrhage	2 (2.0)	0 (0)	2 (2.6)	1.000
Renal failure	1 (1.0)	1 (4.0)	0 (0)	0.250
Urinary retention	2 (2.0)	1 (4.0)	0 (0)	0.250
Abdominal abscess	6 (6.0)	1 (4.0)	5 (6.7)	1.000
Rectovaginal fistula	1 (1.0)	0 (0)	1 (1.3)	1.000
Intra-abdominal hemorrhage	3 (3.0)	0 (0)	3 (4.0)	0.571
Wound infection	3 (3.0)	0 (0)	3 (4.0)	0.571
Time to first flatus, day (mean±SD)	3.5 ± 0.8	5.4 ± 0.9	3.1 ± 0.8	0.008
Time to regular diet, day (mean±SD)	5.8 ± 3.4	7.2 ± 3.6	5.5 ± 3.3	0.122
Postoperative hospital stay, day (mean±SD)	15.3 ± 5.9	19.2 ± 7.4	14.8 ± 5.1	0.018
Re-operation	4 (4.0)	1 (4.0)	3 (4.0)	1.000
Mortality	0 (0)	0 (0)	0 (0)	1.000

Abbreviation: HIPEC, hyperthermic intraperitoneal chemotherapy.

Figure 1 Changes in the neutrophil count in elderly and non-elderly groups on days 1, 3, and 5 after surgery.

Figure 2 Changes in the platelet level in elderly and non-elderly groups on days 1, 3, and 5 after surgery.

Figure 3 Changes in the ALT level in elderly and non-elderly groups on days 1, 3, and 5 after surgery.

Figure 4 Changes in the creatinine level in elderly and non-elderly groups on days 1, 3, and 5 after surgery.

Figure 5 Overall survival curve in entire group.

Figure 6 Overall survival curve in two groups.

Table 3 Univariate and Multivariate Cox Regression Analysis of Overall Survival in 100 Patients After CRS/HIPEC

Variables	Overall Survival
	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	P	HR (95% CI)	P
Gender: female/male	1.43 (0.81–2.52)	0.217
Age at operation (<65 years/≥65 years)	2.57 (1.43–4.60)	0.002	2.42 (1.32–4.45)	0.004
Preoperative chemotherapy (no/yes)	1.05 (0.54–2.01)	0.894
Synchronous/metachronous	0.99 (0.56–1.76)	0.966
Site of original (Colorectum/Appendix)	0.41 (0.13–1.32)	0.135
Histology (adenocarcinoma/mucinous)	1.13 (0.64–2.00)	0.672
Preoperative CEA level	1.01 (1.00–1.01)	0.076
Preoperative CA19-9 level	1.00 (0.99–1.01)	0.202
Liver metastases (no/yes)	1.54 (0.74–3.18)	0.245
HIPEC regimen (lobaplatin/non-lobaplatin)	1.42 (0.79–2.53)	0.298
Presence of ascites (no/yes)	1.32 (0.75–2.33)	0.335
PCI score	1.11 (1.06–1.16)	<0.001	1.10 (1.04–1.16)	0.001
CC score (0–1/2-3)	3.26 (1.83–5.81)	<0.001	1.76 (0.93–3.32)	0.083
Overall postoperative complications (no/yes)	2.55 (1.40–4.62)	0.002	1.43 (0.76–2.68)	0.267
Grade 3–4 Postoperative complication (no/yes)	1.51 (0.82–2.80)	0.184
Neutropenia (no/yes)	0.87 (0.34–2.21)	0.770
Thrombocytopenia (no/yes)	0.98 (0.39–2.48)	0.964

Abbreviations: HIPEC, hyperthermic intraperitoneal chemotherapy; PCI, peritoneal carcinomatosis index; CC score, cytoreduction score.