Skip to main content

Advertisement

SpringerLink
Log in

Age-Related Morbidity and Mortality with Cytoreductive Surgery

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Cytoreduction and intraperitoneal chemotherapy (IPC) are increasingly considered in older patients. We sought to better characterize the influence of age on 30-day outcomes following this procedure.

Methods

The ACS NSQIP database was queried for patients who underwent IPC and a concurrent intra-abdominal operation (2005–2012). Thirty-day death and serious morbidity (DSM) was the primary outcome. Trends in DSM by age were defined using Joinpoint regression. Univariate and multivariate logistic regression identified factors associated with DSM.

Results

In 1085 patients, DSM increased at a significant rate after age 50 (0.6 %/year, p = 0.001). Patients ≥60 (n = 376) represented 35 % of the study population. Age ≥60 years was independently associated with DSM (odds ratio [OR] 1.6, p = 0.001). The older patient population (≥60 years) experienced 44 % morbidity and 3.2 % mortality. In these patients, preoperative weight loss, low preoperative albumin, splenectomy, intraoperative transfusion, contaminated or dirty wound classification, and prolonged operative time were all independently significantly associated with increased DSM. In the absence of these factors (n = 45), the DSM rate was 11 %. Rates of DSM increased to 33, 63, and 100 % in patients with 1 factor, 2–3 factors, and 4 or more factors (n = 14; p < 0.001), respectively. Venous thromboembolism, sepsis, postoperative bleeding, and respiratory complications were significantly more common among those aged 60 years and older (p < 0.05 each).

Conclusions

The risk of DSM increases with age in patients undergoing cytoreduction and IPC. Risk can be stratified using a limited number of patient and operative characteristics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ortman JM. An aging nation: the older population in the United States. 2014; http://www.census.gov/population/projections/data/national/2012.html. Accessed March, 2015.

  2. Howlader N Noone A, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA. SEER Cancer Statistics Review, 1975–2011. 2013; http://seer.cancer.gov/csr/1975_2011. Accessed March, 2015.

  3. Chua TC, Yan TD, Saxena A, Morris DL. Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure? A systematic review of morbidity and mortality. Ann Surg. 2009;249(6):900–7.

    Article  PubMed  Google Scholar 

  4. Bartlett EK, Meise C, Roses RE, Fraker DL, Kelz RR, Karakousis GC. Morbidity and mortality of cytoreduction with intraperitoneal chemotherapy: outcomes from the ACS NSQIP database. Ann Surg Oncol. 2014;21(5):1494–500.

    Article  PubMed  Google Scholar 

  5. Chua TC, Moran BJ, Sugarbaker PH, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449–56.

    Article  PubMed  Google Scholar 

  6. Bartlett EK, Roses RE, Kelz RR, Drebin JA, Fraker DL, Karakousis GC. Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database. Surgery. 2014;156(2):298–304.

    Article  PubMed  Google Scholar 

  7. Kneuertz PJ, Pitt HA, Bilimoria KY, et al. Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg. 2012;16(9):1727–35.

    Article  PubMed  Google Scholar 

  8. Glehen O, Osinsky D, Cotte E, et al. Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol. 2003;10(8):863–9.

    Article  PubMed  CAS  Google Scholar 

  9. Gusani NJ, Cho SW, Colovos C, et al. Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center. Ann Surg Oncol. 2008;15(3):754–63.

    Article  PubMed  Google Scholar 

  10. Kusamura S, Younan R, Baratti D, et al. Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer. 2006;106(5):1144–53.

    Article  PubMed  Google Scholar 

  11. Stephens AD, Alderman R, Chang D, et al. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol. 1999;6(8):790–6.

    Article  PubMed  CAS  Google Scholar 

  12. Votanopoulos KI, Newman NA, Russell G, et al. Outcomes of Cytoreductive Surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients older than 70 years; survival benefit at considerable morbidity and mortality. Ann Surg Oncol. 2013;20(11):3497–503.

    Article  PubMed  Google Scholar 

  13. Spiliotis JD, Halkia E, Boumis VA, Vassiliadou DT, Pagoulatou A, Efstathiou E. Cytoreductive surgery and HIPEC for peritoneal carcinomatosis in the elderly. Int J Surg Oncol. 2014;2014:987475.

    PubMed  CAS  PubMed Central  Google Scholar 

  14. Tabrizian P, Jibara G, Shrager B, et al. Outcomes for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the elderly. Surg Oncol. 2013;22(3):184–9.

    Article  PubMed  Google Scholar 

  15. User Guide for the 2012 Participant Use Data File. American College of Surgeons National Surgical Quality Improvement Program. 2013; http://site.acsnsqip.org/wp-content/uploads/2013/10/ACSNSQIP.PUF_.UserGuide.2012.pdf. Accessed September, 2014.

  16. Raval MV, Hamilton BH, Ingraham AM, Ko CY, Hall BL. The importance of assessing both inpatient and outpatient surgical quality. Ann Surg. 2011;253(3):611–8.

    Article  PubMed  Google Scholar 

  17. Shiloach M, Frencher SK, Jr., Steeger JE, et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2009;210(1):6–16.

    Article  PubMed  Google Scholar 

  18. Bartlett EK, Choudhury RA, Roses RE, Fraker DL, Kelz RR, Karakousis GC. Intraperitoneal chemotherapy at the time of surgery is not associated with increased 30-day morbidity and mortality following colorectal resection. Ann Surg Oncol. 2015;22(5):1664–72.

    Article  PubMed  Google Scholar 

  19. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335–51.

    Article  PubMed  CAS  Google Scholar 

  20. Bartlett EK, Simmons KD, Wachtel H, et al. The rise in metastasectomy across cancer types over the past decade. Cancer. 2014;121(5):747–57.

    Article  PubMed  Google Scholar 

  21. Bartlett EK, Wachtel H, Fraker DL, et al. Surgical palliation for pancreatic malignancy: practice patterns and predictors of morbidity and mortality. J Gastrointest Surg. 2014;18(7):1292–8.

    Article  PubMed  Google Scholar 

  22. Li GZ, Speicher PJ, Lidsky ME, et al. Hepatic resection for hepatocellular carcinoma: do contemporary morbidity and mortality rates demand a transition to ablation as first-line treatment? J Am Coll Surg. 2014;218(4):827–34.

    Article  PubMed  Google Scholar 

  23. Bilimoria KY, Bentrem DJ, Merkow RP, et al. Laparoscopic-assisted vs. open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. J Gastrointest Surg. 2008;12(11):2001–9.

    Article  PubMed  Google Scholar 

  24. Mayo SC, Shore AD, Nathan H, et al. Refining the definition of perioperative mortality following hepatectomy using death within 90 days as the standard criterion. HPB (Oxford). 2011;13(7):473–82.

    Article  Google Scholar 

  25. Vollmer CM, Jr., Sanchez N, Gondek S, et al. A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg. 2012;16(1):89–102; discussion 102-3.

    Article  PubMed  Google Scholar 

  26. Yang XJ, Huang CQ, Suo T, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol. 2011;18(6):1575–81.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jaffer AK, Brotman DJ. Prevention of venous thromboembolism in the geriatric patient. Clin Geriatric Med. 2006;22(1):93–111, ix.

    Article  Google Scholar 

  28. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665–71.

    Article  PubMed  CAS  Google Scholar 

  29. Amador LF, Goodwin JS. Postoperative delirium in the older patient. J Am Coll Surg. 2005;200(5):767–73.

    Article  PubMed  Google Scholar 

  30. Amemiya T, Oda K, Ando M, et al. Activities of daily living and quality of life of elderly patients after elective surgery for gastric and colorectal cancers. Ann Surg. 2007;246(2):222–8.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The ACS NSQIP and participating hospitals are the source of the data used herein. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Madalyn G. Peters MD, Edmund K. Bartlett MD, Robert E. Roses MD, Rachel R. Kelz MD, MSCE, Douglas L. Fraker MD & Giorgos C. Karakousis MD

Authors
  1. Madalyn G. Peters MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edmund K. Bartlett MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert E. Roses MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rachel R. Kelz MD, MSCE
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Douglas L. Fraker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giorgos C. Karakousis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Madalyn G. Peters MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peters, M.G., Bartlett, E.K., Roses, R.E. et al. Age-Related Morbidity and Mortality with Cytoreductive Surgery. Ann Surg Oncol 22 (Suppl 3), 898–904 (2015). https://doi.org/10.1245/s10434-015-4624-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4624-y

Keywords

Search

Navigation