The intersection of age and tumor biology with postoperative outcomes in patients after cytoreductive surgery and HIPEC.

Authors

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Michael K. Turgeon

Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA

Michael K. Turgeon , Adriana C. Gamboa , Rachel M. Lee , Mohammad Yahya Zaidi , Charles Kimbrough , Travis Edward Grotz , Keith F. Fournier , Sean Patrick Dineen , Jula Veerapong , Callisia Clarke , Harveshp Mogal , Sameer H. Patel , Laura A. Lambert , Sean Ronnekleiv-Kelly , Mustafa Raoof , Fabian McCartney Johnston , Charles A. Staley , Jordan Cloyd , Shishir K. Maithel , Joshua H. Winer

Organizations

Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, Department of Surgery, Johns Hopkins University, Baltimore, MD, Emory University, Atlanta, GA

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health

Background: Patient age is often a significant factor in preoperative selection for major abdominal surgery. Its association with postoperative outcomes in patients undergoing cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) remains ill-defined. Methods: The US HIPEC Collaborative database(2000-2017) was reviewed for patients who underwent a CCR0/1 CRS/HIPEC. Age was categorized into < 65 or >65yrs. Primary outcomes were postoperative major complications, readmission, 30-day mortality, and non-home discharge(NHD). Analysis was stratified by disease histology: non-invasive(appendiceal LAMN/HAMN), and invasive(appendiceal/colorectal adenocarcinoma). Results: Of 1090pts identified, 22% were >65yrs(n = 240), 59% were female(n = 646), 25% had non-invasive(n = 276) and 51% had invasive(n = 555) histology. Median PCI was 13(IQR7-20). Patients >65yrs had a higher rate of major complications(37vs26%, p = 0.02), readmission(28vs22%,p = 0.05), 30-day mortality(3vs1%,p = 0.02), and NHD(12vs5%,p < 0.01) compared to those < 65yrs. On multivariable analysis accounting for extent of disease as measured by PCI, for non-invasive histology, age >65yrs was an independent predictor for NHD(OR:2.54,95%CI:1.08-5.99,p = 0.03), but not major complications. For invasive histology, even when accounting for PCI, age >65yrs was an independent predictor for both NHD(OR:2.54,95%CI:1.08-5.98,p = 0.03) and major complications(OR:2.04,95%CI:1.16-3.59,p = 0.05). Age was not associated with hospital readmission or 30-day mortality for any histology. Conclusions: Regardless of histology, patients >65yrs are nearly at three-fold increased risk for non-home discharge after CRS/HIPEC. For invasive histology, age >65yrs is also associated with increased major complication rates, but the procedure seems to be better tolerated when performed for indolent biology. These data inform preoperative counseling and risk stratification. Early planning for discharge disposition in this high-risk population can potentially translate to cost savings.

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Abstract Details

Meeting

2020 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Anal and Colorectal Cancer

Track

Colorectal Cancer,Anal Cancer

Sub Track

Translational Research

Citation

J Clin Oncol 38, 2020 (suppl 4; abstr 184)

Abstract #

184

Poster Bd #

J4

Abstract Disclosures

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