Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases

Mashaal Dhir, Lekshmi Ramalingam, Yongli Shuai, Sam Pakrafter, Heather L. Jones, Melissa E. Hogg, Amer H. Zureikat, Matthew P. Holtzman, Steven A. Ahrendt, Nathan Bahary, James F. Pingpank, Herbert J. Zeh, David L. Bartlett, Haroon A. Choudry

Research output: Contribution to journalArticle

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Abstract

Background: Several studies suggest that young patients may derive less oncologic benefit from surgical resection of cancers compared with older patients. We hypothesized that young patients may have worse outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for peritoneal metastases. Methods: Perioperative and oncologic outcomes in adolescent and young adults (AYA), defined as younger than age 40 years (n = 135), undergoing CRS/HIPEC between 2001 and 2015 were reviewed and compared with middle-aged adults, defined as aged 40–65 years (n = 684). Results: The two groups were similar with regards to perioperative characteristics except that AYA were more likely to be symptomatic at presentation (65.2 vs. 50.9%, p = 0.003), had lower Charleson comorbidity index (median 6 vs. 8, p < 0.001), were less likely to receive neoadjuvant chemotherapy (32.8 vs. 42.5%, p = 0.042), and had longer operative times (median 543 vs. 493 min, p = 0.010). Postoperative Clavien–Dindo grade 3–4 morbidity was lower in AYA (17 vs. 26%, p = 0.029), and they required fewer reoperations for complications (3.7 vs. 10.4%, p = 0.014). AYA had longer median overall survival (103.6 vs. 73.2 months, p = 0.053). In a multivariate Cox regression analysis, age was an independent predictor of improved overall survival [hazard ratio 0.705; 0.516–0.963, p = 0.028]. Conclusions: Young patients with peritoneal metastases derive similar benefits from CRS/HIPEC as middle-aged patients. Young age should not be a deterrent to consideration of CRS/HIPEC for peritoneal metastases.

Original languageEnglish (US)
Pages (from-to)875-883
Number of pages9
JournalAnnals of Surgical Oncology
Volume24
Issue number4
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

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Young Adult
Neoplasm Metastasis
Survival
Operative Time
Reoperation
Comorbidity
Regression Analysis
Morbidity
Drug Therapy
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases. / Dhir, Mashaal; Ramalingam, Lekshmi; Shuai, Yongli; Pakrafter, Sam; Jones, Heather L.; Hogg, Melissa E.; Zureikat, Amer H.; Holtzman, Matthew P.; Ahrendt, Steven A.; Bahary, Nathan; Pingpank, James F.; Zeh, Herbert J.; Bartlett, David L.; Choudry, Haroon A.

In: Annals of Surgical Oncology, Vol. 24, No. 4, 01.04.2017, p. 875-883.

Research output: Contribution to journalArticle

Dhir, M, Ramalingam, L, Shuai, Y, Pakrafter, S, Jones, HL, Hogg, ME, Zureikat, AH, Holtzman, MP, Ahrendt, SA, Bahary, N, Pingpank, JF, Zeh, HJ, Bartlett, DL & Choudry, HA 2017, 'Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases', Annals of Surgical Oncology, vol. 24, no. 4, pp. 875-883. https://doi.org/10.1245/s10434-016-5689-y
Dhir, Mashaal ; Ramalingam, Lekshmi ; Shuai, Yongli ; Pakrafter, Sam ; Jones, Heather L. ; Hogg, Melissa E. ; Zureikat, Amer H. ; Holtzman, Matthew P. ; Ahrendt, Steven A. ; Bahary, Nathan ; Pingpank, James F. ; Zeh, Herbert J. ; Bartlett, David L. ; Choudry, Haroon A. / Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases. In: Annals of Surgical Oncology. 2017 ; Vol. 24, No. 4. pp. 875-883.
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abstract = "Background: Several studies suggest that young patients may derive less oncologic benefit from surgical resection of cancers compared with older patients. We hypothesized that young patients may have worse outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for peritoneal metastases. Methods: Perioperative and oncologic outcomes in adolescent and young adults (AYA), defined as younger than age 40 years (n = 135), undergoing CRS/HIPEC between 2001 and 2015 were reviewed and compared with middle-aged adults, defined as aged 40–65 years (n = 684). Results: The two groups were similar with regards to perioperative characteristics except that AYA were more likely to be symptomatic at presentation (65.2 vs. 50.9{\%}, p = 0.003), had lower Charleson comorbidity index (median 6 vs. 8, p < 0.001), were less likely to receive neoadjuvant chemotherapy (32.8 vs. 42.5{\%}, p = 0.042), and had longer operative times (median 543 vs. 493 min, p = 0.010). Postoperative Clavien–Dindo grade 3–4 morbidity was lower in AYA (17 vs. 26{\%}, p = 0.029), and they required fewer reoperations for complications (3.7 vs. 10.4{\%}, p = 0.014). AYA had longer median overall survival (103.6 vs. 73.2 months, p = 0.053). In a multivariate Cox regression analysis, age was an independent predictor of improved overall survival [hazard ratio 0.705; 0.516–0.963, p = 0.028]. Conclusions: Young patients with peritoneal metastases derive similar benefits from CRS/HIPEC as middle-aged patients. Young age should not be a deterrent to consideration of CRS/HIPEC for peritoneal metastases.",
author = "Mashaal Dhir and Lekshmi Ramalingam and Yongli Shuai and Sam Pakrafter and Jones, {Heather L.} and Hogg, {Melissa E.} and Zureikat, {Amer H.} and Holtzman, {Matthew P.} and Ahrendt, {Steven A.} and Nathan Bahary and Pingpank, {James F.} and Zeh, {Herbert J.} and Bartlett, {David L.} and Choudry, {Haroon A.}",
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T1 - Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases

AU - Dhir, Mashaal

AU - Ramalingam, Lekshmi

AU - Shuai, Yongli

AU - Pakrafter, Sam

AU - Jones, Heather L.

AU - Hogg, Melissa E.

AU - Zureikat, Amer H.

AU - Holtzman, Matthew P.

AU - Ahrendt, Steven A.

AU - Bahary, Nathan

AU - Pingpank, James F.

AU - Zeh, Herbert J.

AU - Bartlett, David L.

AU - Choudry, Haroon A.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background: Several studies suggest that young patients may derive less oncologic benefit from surgical resection of cancers compared with older patients. We hypothesized that young patients may have worse outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for peritoneal metastases. Methods: Perioperative and oncologic outcomes in adolescent and young adults (AYA), defined as younger than age 40 years (n = 135), undergoing CRS/HIPEC between 2001 and 2015 were reviewed and compared with middle-aged adults, defined as aged 40–65 years (n = 684). Results: The two groups were similar with regards to perioperative characteristics except that AYA were more likely to be symptomatic at presentation (65.2 vs. 50.9%, p = 0.003), had lower Charleson comorbidity index (median 6 vs. 8, p < 0.001), were less likely to receive neoadjuvant chemotherapy (32.8 vs. 42.5%, p = 0.042), and had longer operative times (median 543 vs. 493 min, p = 0.010). Postoperative Clavien–Dindo grade 3–4 morbidity was lower in AYA (17 vs. 26%, p = 0.029), and they required fewer reoperations for complications (3.7 vs. 10.4%, p = 0.014). AYA had longer median overall survival (103.6 vs. 73.2 months, p = 0.053). In a multivariate Cox regression analysis, age was an independent predictor of improved overall survival [hazard ratio 0.705; 0.516–0.963, p = 0.028]. Conclusions: Young patients with peritoneal metastases derive similar benefits from CRS/HIPEC as middle-aged patients. Young age should not be a deterrent to consideration of CRS/HIPEC for peritoneal metastases.

AB - Background: Several studies suggest that young patients may derive less oncologic benefit from surgical resection of cancers compared with older patients. We hypothesized that young patients may have worse outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for peritoneal metastases. Methods: Perioperative and oncologic outcomes in adolescent and young adults (AYA), defined as younger than age 40 years (n = 135), undergoing CRS/HIPEC between 2001 and 2015 were reviewed and compared with middle-aged adults, defined as aged 40–65 years (n = 684). Results: The two groups were similar with regards to perioperative characteristics except that AYA were more likely to be symptomatic at presentation (65.2 vs. 50.9%, p = 0.003), had lower Charleson comorbidity index (median 6 vs. 8, p < 0.001), were less likely to receive neoadjuvant chemotherapy (32.8 vs. 42.5%, p = 0.042), and had longer operative times (median 543 vs. 493 min, p = 0.010). Postoperative Clavien–Dindo grade 3–4 morbidity was lower in AYA (17 vs. 26%, p = 0.029), and they required fewer reoperations for complications (3.7 vs. 10.4%, p = 0.014). AYA had longer median overall survival (103.6 vs. 73.2 months, p = 0.053). In a multivariate Cox regression analysis, age was an independent predictor of improved overall survival [hazard ratio 0.705; 0.516–0.963, p = 0.028]. Conclusions: Young patients with peritoneal metastases derive similar benefits from CRS/HIPEC as middle-aged patients. Young age should not be a deterrent to consideration of CRS/HIPEC for peritoneal metastases.

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