scholarly journals Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis in the Elderly

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
J. D. Spiliotis ◽  
E. Halkia ◽  
V. A. Boumis ◽  
D. T. Vassiliadou ◽  
A. Pagoulatou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Combined Treatment ◽  
Group Versus ◽  
Disease Free Survival ◽  
The Elderly ◽  
Morbidity Rate ◽  
Crs And Hipec

Background. The combined treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is a rigorous surgical treatment, most suitable for young and good performance status patients. We evaluated the outcomes of elderly patients undergoing CRS and HIPEC for peritoneal carcinomatosis with careful perioperative care.Methods. All consecutive patients 70 years of age or older who were treated for peritoneal carcinomatosis over the past five years were included. Primary outcomes were perioperative morbidity and mortality. Secondary outcomes were disease-free survival and overall survival.Results. From a pool of 100 patients, with a diagnosis of PC who underwent CRS and HIPEC in our center, we have included 30 patients at an age of 70 years or older and the results were compared to the patients younger than 70 years. The total morbidity rate was 50% versus 41.5% in the group younger than 70 years (NSS). The mortality rate was 3.3% in the elderly group versus 1.43% in the younger group (NSS). Median overall survival was 30 months in the older group versus 38 months in the younger group.Conclusion. Cytoreductive surgery and HIPEC for peritoneal carcinomatosis may be safely performed with acceptable morbidity in selected elderly patients.

scholarly journals Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from colorectal and appendiceal cancer: five-years of experience

2016 ◽  
Author(s):  
Giulia Montori ◽  
Paola Fugazzola ◽  
Marco Ceresoli ◽  
Andrea Gianatti ◽  
Vincenzo Gatti ◽  
...  
Keyword(s):  
Overall Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Combined Treatment ◽  
Disease Free Survival ◽  
Appendiceal Cancer ◽  
Free Survival ◽  
Crs And Hipec ◽  
Disease Free

An increasing promising evidence support the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of peritoneal carcinosis from colorectal cancer (CRC) and appendiceal cancer (AC). In our institute 18 patients with CRC and 4 patients with AC undergone to CRS and HIPEC were retrospectively analyzed from 2011 to 2016. Patients and tumor characteristics were analyzed. Overall survival and disease free survival were analyzed with Kaplan-Meier curves and log-rank testing. Median disease free survival (DFS) is 20.5 and 31.4 months in CRC and AC respectively (P=0.76). Instead mean overall survival is 37.8 and 44.6 months in CRC and AC group respectively (P=0.46). Primary CRC have an improved DFS compared patients with relapse tumor (45.2 versus 19.4 months) (P=0.037). Comparing with conventional chemotherapy regimens CRS and HIPEC from CRC and AC may obtain a better disease control particularly when a complete cytoreduction is achieved. The combined treatment can have a potential curative intent.

Cytoreductive surgery combined with peritoneal intraoperative heated chemotherapy for management of peritoneal carcinomatosis in 59 adults older than age 65

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20657-e20657
Author(s):  
I. Bereder ◽  
O. Guerin ◽  
R. Boulahssass ◽  
A. Couderc ◽  
V. Mailland ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Nutritional Assessment ◽  
Performance Status ◽  
Combined Treatment ◽  
Disease Free Survival ◽  
Prognostic Indicators ◽  
Morbidity Rate ◽  
Term Survival ◽  
Free Survival

e20657 Background: Peritoneal carcinomatosis (PC) has long been regarded as a terminal disease with short median survival. Recent success of new approach, combining surgery and intraperitoneal heated chemotherapy (HIPEC) are reported. But in the most studies patients over 65 years are excluded. We report our experience in this selected group of patients. Methods: A retrospective study was performed to evaluate toxicity and to identify the principal prognostic indicators with this combined treatment. All patients had cytoreductive surgery and HIPEC. This population of patients was compared with younger over the same period. We have excluded patient with frailty by comprehensive onco-geriatric assessment based upon cognitive, nutritional assessment and cormorbidities. Results: The study included 291 procedures in 249 patients between 2000 and 2008. 64 procedures were performed in 59 older patients (group 1) and 227 procedures in 190 younger patients (group 2). The principal etiologies of PC in group1 were recurrent ovarian cancer (N=33), colorectal cancer (N=9), peritoneal mesothelioma (N=6), pseudomyxoma (N=9) and sarcomatosis (N=2). No death occurred in post operative course and the procedure related morbidity rate was 10%. 5 years overall and free survival rate were respectively 33% and 15%. Median overall survival was 44 months and median disease free survival was 13 months. There were no difference between group1 and 2 for survival. Independent prognostic factors for survival by multivariate analysis were extent of carcinomatosis, completeness of cytoreductive surgery and performance status. Conclusions: Therapeutic approach combining cytoreductive surgery with HIPEC may achieve long-term survival in a selected group of patients with PC with acceptable mortality and morbidity. For elderly patients, this treatment could be performed in selected cases without frailty. No significant financial relationships to disclose.

Lobar versus Sublobar Resection in the Elderly for Early Lung Cancer: A Meta-Analysis

2021 ◽  
Author(s):  
Josiah Ng ◽  
Yoshio Masuda ◽  
Jun Jie Ng ◽  
Lowell Leow ◽  
Andrew M. T. L. Choong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Meta Analysis ◽  
Cancer Recurrence ◽  
Disease Free Survival ◽  
The Elderly ◽  
Sublobar Resection ◽  
Cell Lung Carcinoma ◽  
Risk Of Death ◽  
Stage 1

Abstract Objectives We performed a systematic review and meta-analysis of outcomes of lobectomy versus sublobar resection in elderly patients (≥65) with stage 1 nonsmall cell lung carcinoma (NSCLC). Methods We searched for relevant articles using a set of inclusion and exclusion criteria. Meta-analytic techniques were applied. Results Twelve studies (n = 5834) were chosen. Our results indicate that in the elderly, lobectomy for stage 1 NSCLC confers a survival advantage over sublobar resection. Lobectomy patients had a lower risk of death within 5 years and lower odds of local cancer recurrence. Our results show that lobectomy had a better 5-year cancer-specific survival and 5-year disease-free survival that trended toward significance. The sublobar resection group showed better 30-day operative mortality that trended toward significance. Subgroup analysis of stage 1A cancer demonstrated no difference in 5-year overall survival rates. However, for stage 1B tumors 5-year overall survival favored lobectomy. Conclusion Lobectomy for stage 1 NSCLC in elderly patients is superior to sublobar resection in terms of survival and cancer recurrence and should be afforded where possible. For stage 1A tumors, sublobar resection is noninferior and may be considered. Further randomized controlled trials in this topic is required.

scholarly journals Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review

2016 ◽  
Vol 1 (2) ◽  
pp. 67-77 ◽  
Author(s):  
Claramae Shulyn Chia ◽  
Ramakrishnan Ayloor Seshadri ◽  
Vahan Kepenekian ◽  
Delphine Vaudoyer ◽  
Guillaume Passot ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Median Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Current Evidence ◽  
Term Survival ◽  
Crs And Hipec

AbstractBackground: The current treatment of choice for peritoneal carcinomatosis from gastric cancer is systemic chemotherapy. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a new aggressive form of loco-regional treatment that is currently being used in pseudomyxoma peritoneii, peritoneal mesothelioma and peritoneal carcinomatosis from colorectal cancer. It is still under investigation for its use in gastric cancer.Methods: The literature between 1970 and 2016 was surveyed systematically through a review of published studies on the treatment outcomes of CRS and HIPEC for peritoneal carcinomatosis from gastric cancer.Results: Seventeen studies were included in this review. The median survival for all patients ranged from 6.6 to 15.8 months. The 5-years overall survival ranged from 6 to 31%. For patients with complete cytoreduction, the median survival was 11.2 to 43.4 months and the 5-years overall survival was 13 % to 23%. Important prognostic factors were found to be a low peritoneal carcarcinomatosis index (PCI) score and the completeness of cytoreduction.Conclusion: The current evidence suggests that CRS and HIPEC has a role to play in the treatment of peritoneal carcinomatosis from gastric cancer. Long term survival has been shown for a select group of patients. However, further studies are needed to validate these results.

Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from ovarian cancer: A multiinstitutional study of 246 patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5542-5542 ◽  
Author(s):  
J. Bereder ◽  
O. Glehen ◽  
J. Habre ◽  
M. Desantis ◽  
E. Cotte ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Prognostic Factors ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Disease Free Survival ◽  
Morbidity Rate ◽  
Free Survival ◽  
Group 1

5542 Background: Optimal treatment of chemoresistant and recurrent ovarian cancer is debating with second line chemotherapies. For peritoneal carcinomatosis new treatment combining cytoreductive surgery with heated intraperitoneal per operative chemotherapy (HIPEC) may improve survival. Methods: Retrospective bicentric study of 246 patients with peritoneal carcinomatosis from ovarian cancer were performed to evaluate HIPEC and to identify prognostic factors. Peritoneal Cancer Index (PCI) assess tumor load and completeness cytoreductive score (CCS) was used to give quality of resection CC0 (no visible tumor), CC1 (persistent diffuse lesions < 2.5mm), CC2 (2.5mm < CC2 < 25mm) and over CC3 status. HIPEC is performed with platinum based regimen at 42°C. Endpoint was survival. Kaplan-Meier survival curve was fitted to the data. Cox's regression model was used for multivariate survival analysis. Results: The study included 268 procedures in 246 patients from 1991 to 2008. 206 procedures were performed in 184 patients with recurrence (Group 1) and 62 in chemoresistant patients (Group 2). After completion of resection the allocation of CCS was CC0 = 164, CC1 = 83, CC2 = 15, and CC3 = 5. Only 1 patient died in post operative course and procedure related morbidity rate was 12%. 5 years overall and free survival were respectively 35 % and 10%. Median overall survival was 49 months and the median disease free survival was 13 months. There was no difference between group 1 and 2 for survival. Independent prognostic factors for survival were the carcinomatosis extent, the completeness of cytoreductive surgery (HR = 2.26 IC95 [1.3–3.91]), performance status (HR = 4.3 IC95 [1.23–14.4]) and redo procedure (HR = 0.9 IC95 [0.001–0.9]). Conclusions: Hipec is a standardized and reproducible feasible method. Less extensive disease and the quality of cytoreduction remain an independent factor of better outcome. Morbidity is acceptable. To date in selected patients, HIPEC allows to reach the longest median time survival in recurrent peritoneal carcinomatosis from ovarian cancer. No significant financial relationships to disclose.

Systematic review of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for ovarian peritoneal carcinomatosis: A more efficacious way of delivering intraperitoneal chemotherapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5524-5524 ◽  
Author(s):  
T. C. Chua ◽  
G. Robertson ◽  
R. Farrell ◽  
W. Liauw ◽  
T. D. Yan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ovarian Cancer ◽  
Peritoneal Carcinomatosis ◽  
Median Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Combined Treatment ◽  
Disease Free Survival ◽  
Current Evidence

5524 Background: Advanced and recurrent ovarian cancer results in extensive dissemination of tumor within the peritoneal cavity. The current evidence suggests that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may be a feasible option with potential benefits compared to the current standard of care in the treatment of peritoneal carcinomatosis from ovarian cancer. Methods: A systematic review of relevant studies before August 2008 was undertaken to document and report its efficacy. Each study was appraised using a predetermined protocol. The quality of studies was assessed. The patient characteristics, protocol of treatment, perioperative morbidity and mortality, and treatment outcomes were synthesized through a narrative review with full tabulation of results of all included studies. Results: In total, 15 non-randomized, observational studies were reviewed, comprising of 512 patients. All patients received HIPEC as part of the combined treatment with cytoreductive surgery. Cisplatin was the most common chemoperfusate. The mortality associated with the treatment ranged from 0 to 10%. The rates of severe morbidity ranged from 0 to 40%. The median time of follow up ranged from 14 to 64 months, the median disease-free survival ranged from 10 to 57 months and the overall median survival ranged from 22 to 64 months. In patients who had an optimal cytoreduction, the median survival ranged from 29 to 66 months, with a 3- and 5-year survival rate that ranged from 35 to 63% and 12 to 66%, respectively. Conclusions: The future for cytoreductive surgery and HIPEC in ovarian cancer is promising. More studies are called for to validate the efficacy of this treatment. For it to become generally accepted, the oncology community must commit to a randomized trial. Before this, the current treatment of cytoreductive surgery combined with adjuvant intraperitoneal and intravenous chemotherapy should remain the mainstay of treatment. No significant financial relationships to disclose.

scholarly journals Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy Experience in Peritoneal Carcinomatosis: Single-Center Analysis of 180 Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Kursat Karadayi ◽  
Meric Emre Bostanci ◽  
Murat Can Mollaoglu ◽  
Ufuk Karabacak
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Demographic Data ◽  
Disease Free Survival ◽  
Operation Time ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Survival Times

Background. In peritoneal carcinomatosis (PC), increased life span and disease-free survival times are shown in patients with hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) following cytoreductive surgery (SRC). In this study, our main objective was to present our experience of performing SRC and perioperative intraperitoneal chemotherapy (HIPEC and EPIC) on patients with PC, in light of the literature. Methods. Demographic data, follow-up results, peritoneal carcinomatosis index (PCI), completeness of cytoreduction (CCR) score, and morbidity and mortality rates of 180 patients treated with SRC + HIPEC + EPIC for PC at the Department of Surgical Oncology at Sivas Cumhuriyet University between January 2008 and July 2020 were analyzed retrospectively. Results. Distribution of 180 PC cases according to primary organs included 53 ovarian, 39 colorectal, 33 stomach, 25 primary peritoneum, 10 uterus, 10 tuba, five soft tissue, and five appendix originated carcinoma. The average PCI of the cases detected preoperatively was 21 (5–30). Completeness of cytoreduction scores of CCR-0 in 102 cases, CCR-1 in 67 cases, CCR-2 in eight cases, and CCR-3 in three cases was obtained. Median operation time was 300 (200–540) minutes. Perioperative morbidity rate was 47.0%, and perioperative mortality rate was 13.5%. Conclusion. The peritonectomy procedure is a difficult, long-lasting, troublesome intervention, but it is the most important treatment option with acceptable morbidity and mortality rates in patients selected for PC treatment in experienced centers.

Comparison of open and closed techniques of delivery of hyperthermic chemotherapy following cytoreductive surgery in patients with peritoneal carcinomatosis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14067-14067
Author(s):  
A. Sardi ◽  
V. Thillainathan ◽  
C. Nieroda ◽  
B. Merriman ◽  
P. N. Kostuik
Keyword(s):  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Disease Free Survival ◽  
Open Technique ◽  
Free Survival ◽  
Closed Technique ◽  
Hyperthermic Chemotherapy ◽  
Significant Difference ◽  
Disease Free

14067 Background: Intraperitoneal hyperthermic chemotherapy (IPHC) combined with Cytoreductive surgery (CRS) is an effective approach in the management of peritoneal carcinomatosis. A controversy exists concerning the use of an open or closed technique of delivery of the hyperthermic chemotherapy. A retrospective study of a prospective data base was performed to compare these two techniques with respect to overall survival, disease-free survival, length of hospital stay (LOS), and incidence of complications. Methods: From 1998 to 2005, 64 patients underwent CRS and IPHC. Nineteen patients underwent open technique and forty-five underwent closed technique. The pathological diagnoses included appendiceal carcinoma (35), pseudomyxoma peritonei (10), ovarian carcinoma (7), colon carcinoma (6), mesothelioma (5), and sarcoma (1). Cox Proportional-Hazards Regression analysis was performed. Results: Overall 5- year survival and disease free survival was 46% and 22%, respectively. No significant difference in overall survival (p=0.58), disease-free survival (p=0.37), or incidence of complications (p=0.66) was found between the groups. Open technique patients had a significantly shorter LOS than closed with a mean of 8.7 vs. 11.4 days [p=0.01] and a median of 8 vs.11 days [p=0.002] (Kruskal-Wallis Rank Sum Test). Conclusions: The improved survival seen in patients undergoing CRS and IPHC is not dependent on the choice of technique of delivery of the hyperthermic chemotherapy No significant financial relationships to disclose.

scholarly journals Effect of timing of surgical resection of primary hepatocellular carcinoma on survival outcomes in elderly patients and prediction of clinical models

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yongfei He ◽  
Tianyi Liang ◽  
Shutian Mo ◽  
Zijun Chen ◽  
Shuqi Zhao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Liver Cancer ◽  
Elderly Patients ◽  
Surgical Resection ◽  
Influencing Factors ◽  
The Elderly ◽  
Primary Hepatocellular Carcinoma ◽  
Surgical Timing ◽  
Duration Of Surgery

Abstract Background The effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients. Methods A retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed. Results A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival. Conclusions We demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.

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