Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Ann Surg Oncol. 2020 Dec;27(13):4894-4907. doi: 10.1245/s10434-020-08538-y. Epub 2020 May 6.
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.
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).
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.
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.
患者年龄是进行重大腹部手术术前选择的重要因素。在接受细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）的患者中，年龄、肿瘤生物学和术后结果之间的关系仍未明确。
对 2000 年至 2017 年期间美国 HIPEC 协作数据库中接受 CCR0/1 CRS/HIPEC 的患者进行回顾性分析。将年龄分为<65 岁或≥65 岁。主要结局为术后主要并发症。次要结局是非居家出院（NHD）和再入院。根据疾病组织学进行分层分析：非侵袭性（阑尾 LAMN/HAMN）和侵袭性（阑尾/结直肠癌腺癌）。
在确定的 1090 名患者中，22%的患者≥65 岁（n=240），59%为女性（n=646），25%为非侵袭性（n=276），51%为侵袭性（n=555）组织学。PCI 中位数为 13（IQR 7-20）。与<65 岁的患者相比，≥65 岁的患者主要并发症发生率更高（37% vs 26%，p=0.02），NHD 发生率更高（12% vs 5%，p<0.01），再入院率更高（28% vs 22%，p=0.05）。对于非侵袭性组织学，多变量分析显示年龄≥65 岁与主要并发症或 NHD 无关。对于侵袭性组织学，在考虑 PCI 和 CCR 后，年龄≥65 岁与主要并发症相关（OR 2.04，95%CI 1.16-3.59，p=0.01）。在考虑主要并发症后，年龄≥65 岁与 NHD 相关（OR 2.54，95%CI 1.08-5.98，p=0.03）。在考虑主要并发症后，对于任何组织学类型，年龄≥65 岁与再入院无关。
对于侵袭性组织学，年龄≥65 岁是术后主要并发症和非居家出院的独立预测因素，但对于非侵袭性组织学不是。这些数据为术前咨询、风险分层和早期出院计划提供了信息。
