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Clinical Studies

Age alone is not a barrier to efficacy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: analysis of 1138 patients from the UK and Ireland Colorectal Peritoneal Metastases Registry

British Journal of Cancer volume 128, pages 42–47 (2023)Cite this article

Subjects

Abstract

Background

The management of colorectal peritoneal metastases continues to be a challenge but recent evidence suggests cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can improve survival. Uncertainty about the relationship between age and tumour biology makes patient selection challenging particularly when reported procedure related morbidity is high and impact on survival outcomes unknown. The UK and Ireland Colorectal Peritoneal Metastases Registry was reviewed to assess the influence of age on efficacy of CRS and HIPEC.

Methods

A review of outcomes from the UK and Ireland Colorectal Peritoneal Metastases Registry was performed. Data from 2000 to 2021 were included from five centres in the UK and Ireland, and the cohort were sub-divided into three age groups; <45 years, 45–65 years and >65 years old. Primarily, we examined post-operative morbidity and survival outcomes across the three age groups. In addition, we examined the impact that the completeness of cytoreduction, nodal status, or adverse pathological features had on long-term survival.

Results

During the study period, 1138 CPM patients underwent CRS HIPEC. 202 patients(17.8%) were <45 years, 549 patients(48.2%) aged 45–65 years and 387 patients(34%) >65 years. Overall, median length of surgery (CRS and HIPEC), median PCI score and rate of HIPEC administration was similar in all three groups, as was overall rates of major morbidity and/or mortality. Complete cytoreduction rates (CC0) were similar across the three cohorts; 77%, 80.6% and 81%, respectively. Median overall survival for all patients was 38 months following complete cytoreduction.

Conclusion

Age did not appear to influence morbidity or long-term survival following CRS and HIPEC. When complete cytoreduction is achieved survival outcomes are good. The addition of HIPEC can be performed safely and may reduce local recurrence within the peritoneum.

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Fig. 1
Fig. 2: Kaplan-Meier curve showing the three age cohorts, comparing CC0 vs. CC1+

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Data availability

The datasets generated during and/or analysed during the current study are available in the Pelican Cancer Foundation Repository as part of the UK & Ireland Colorectal Peritoneal Metastases Registry.

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Acknowledgements

Thanks to support of Pelican Cancer Foundation.

Author information

Authors and Affiliations

  1. Mater Misericordiae University Hospital, Dublin, Ireland

    Michael E. Kelly, Niall J. O’Sullivan, Jarlath C. Bolger, Jürgen Mulsow, Ronan Cahill, Faraz Khan, Edward Murphy & Connor Shields

  2. Ninewells Hospital, Dundee, UK

    Francesco Polignano

  3. Good Hope Hospital, Heart of England NHS Foundation Trust—University of Birmingham, Birmingham, UK

    Haney Youssef

  4. Christie NHS Foundation Trust, Manchester, UK

    Andrew Renehan, Lee Malcomson, Sanjeev Dayal, Alexios Tzivanakis & Jonathan Wild

  5. Peritoneal Malignancy Institute Basingstoke, Basingstoke, UK

    Sue Alves, Tom Cecil, Brendan Moran & Faheez Mohamed

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  1. Michael E. Kelly
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Consortia

UK & Ireland Colorectal Peritoneal Metastases Registry

  • Sue Alves
  • , Jarlath C. Bolger
  • , Ronan Cahill
  • , Tom Cecil
  • , Michael E. Kelly
  • , Faraz Khan
  • , Faheez Mohamed
  • , Lee Malcomson
  • , Jürgen Mulsow
  • , Edward Murphy
  • , Brendan Moran
  • , Niall J. O’Sullivan
  • , Francesco Polignano
  • , Andrew Renehan
  • , Sanjeev Dayal
  • , Connor Shields
  • , Alexios Tzivanakis
  • , Jonathan Wild
  •  & Haney Youssef

Contributions

Design (MK,FP, HY, AR, JM, FM), Data collection (MK, NOS, JB, LM, SA, JM, BM), Interpretation and analysis (MK, JB, FP, HY, AR, LM, JM, BM, TC, FM) and Manuscript production (MK, NOS, JB, FP, HY, AR, SA, LM, JM, BM, TC, FM).

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Correspondence to Michael E. Kelly.

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Kelly, M.E., O’Sullivan, N.J., Bolger, J.C. et al. Age alone is not a barrier to efficacy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: analysis of 1138 patients from the UK and Ireland Colorectal Peritoneal Metastases Registry. Br J Cancer 128, 42–47 (2023). https://doi.org/10.1038/s41416-022-02037-5

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