Department of Interventional Radiotherapy, Huzhou Cent Hospital, Affiliated Cent Hospital HuZhou University, Zhejiang Province, P.R. China.
Eur Rev Med Pharmacol Sci. 2021 Sep;25(17):5330-5348. doi: 10.26355/eurrev_202109_26640.
Peritoneal cancer is an uncommon form of terminal malignancy with substantial morbidity and mortality. While both young and elderly population groups with peritoneal cancer are treated by joint cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, studies suggest that they might have a differential prognostic outcome in terms of postoperative morbidity and mortality. To date, only one review has attempted to evaluate the comparative impact of postoperative complications and overall mortality in these age groups. However, a recent publication of several high-quality cohort trials needs an update of the existing consensus. To compare the impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on postoperative complications and overall mortality in younger and elderly population groups.
A systematic search of the academic literature was performed according to the PRISMA guidelines across five databases: Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE. A random-effect meta-analysis was conducted to evaluate the comparative outcomes between the impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on postoperative complications and overall mortality in younger and elderly population groups.
From 963 studies, 16 eligible studies that evaluated the comparative outcomes of morbidity and mortality between 3067 young and 878 elderly patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were included. A meta-analysis revealed higher risks of postoperative complications (Odds ratio: 1.18, 95% C.I: 0.90 to 1.55) and overall mortality (3.28, 1.93 to 5.5) for elderly patients as compared to the younger patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. There were no differences in risks of the onset of anastomotic leakage (1.0, 0.47 to 2.14) and duration of hospital stay (Hedge's g: 0.02, -0.08 to 0.14) between elderly and younger patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
The study provides updated evidence regarding poor postoperative morbidity and mortality outcomes in elderly patients as compared to younger patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and may help clinicians to better stratify the risks associated with the conventional management of peritoneal carcinomatosis in elderly population groups.
腹膜癌是一种罕见的终末期恶性肿瘤，发病率和死亡率都很高。虽然接受细胞减灭术和腹腔热灌注化疗的腹膜癌患者既有年轻人也有老年人，但研究表明，他们在术后发病率和死亡率方面可能有不同的预后结果。迄今为止，只有一项研究试图评估这两个年龄组术后并发症和总死亡率的比较影响。然而，最近发表的几项高质量队列研究需要更新现有的共识。比较细胞减灭术和腹腔热灌注化疗对年轻和老年人群术后并发症和总死亡率的影响。
根据 PRISMA 指南，在五个数据库（Web of Science、EMBASE、CENTRAL、Scopus 和 MEDLINE）中进行了系统的文献检索。采用随机效应荟萃分析评估细胞减灭术和腹腔热灌注化疗对年轻和老年人群术后并发症和总死亡率的比较影响。
从 963 项研究中，纳入了 16 项评估 3067 名年轻患者和 878 名老年患者接受细胞减灭术和腹腔热灌注化疗的发病率和死亡率比较结果的合格研究。荟萃分析显示，与接受细胞减灭术和腹腔热灌注化疗的年轻患者相比，老年患者术后并发症（优势比：1.18，95%置信区间：0.90 至 1.55）和总死亡率（3.28，1.93 至 5.5）的风险更高。老年患者和年轻患者在吻合口漏的发生风险（1.0，0.47 至 2.14）和住院时间（ Hedge's g：0.02，-0.08 至 0.14）方面无差异。
该研究提供了关于与接受细胞减灭术和腹腔热灌注化疗的年轻患者相比，老年患者术后发病率和死亡率较差的最新证据，这可能有助于临床医生更好地评估老年人群中腹膜癌常规治疗相关的风险。
