Journal
ANNALS OF SURGICAL ONCOLOGY
Volume 26, Issue 3, Pages 845-851Publisher
SPRINGER
DOI: 10.1245/s10434-018-07087-9
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BackgroundColonoscopy to detect colorectal cancer (CRC) is recommended starting at age 50years; however, CRC rates are increasing in the prescreening population. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been proven effective in select patients with peritoneal carcinomatosis (PC) from CRC, although it has not been evaluated specifically in patients <50years.MethodsCRC patients aged <50years at diagnosis undergoing CRS/HIPEC 2007-2017 were compared with those aged 50years. Age distribution was analyzed in patients undergoing colectomy alone versus CRS/HIPEC for CRC 1993-2013.ResultsA total of 98 patients underwent CRS/HIPEC, of which 44% were <50years. Younger patients were more likely to present with synchronous peritoneal metastases (p=0.050). Receipt of perioperative chemotherapy was comparable (p=not significant [NS]). Charlson Comorbidity Index and ECOG score were similar (p=NS). Tumor grade was similar (p=NS). Peritoneal Carcinomatosis Index, total organs resected, and anastomoses created were comparable (p=NS). Major Clavien-Dindo morbidity and LOS were similar (p=NS). Younger patients survived longer after CRS/HIPEC (p=0.011). Demographic data from patients undergoing colectomy (n=225) and CRS/HIPEC (n=98) showed that age <50years was increasingly common with the more aggressive procedure (9% and 44% respectively, p<0.001).ConclusionsYounger patients with PC from CRC presented more often with peritoneal metastases at the time of diagnosis. Yet despite similar perioperative features at CRS/HIPEC, they survived longer than older patients. Patients undergoing CRS/HIPEC are overall younger than those undergoing index colectomy.
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