Morbidity and Mortality of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients Aged 70 Years and Older: A Two-Center 10-Year Experience.

BACKGROUND AND OBJECTIVES: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is established for peritoneal surface malignancies, but its use in older patients is debated. We assessed CRS-HIPEC morbidity and mortality in patients aged ≥ 70 years using a cohort of younger patients as a comparator. METHODS: We retrospectively reviewed consecutive patients aged ≥ 70 and < 70 undergoing CRS-HIPEC for peritoneal carcinomatosis at two centers (2017-2026). Peritoneal carcinomatosis index (PCI), completeness of cytoreduction (CC), complications (Clavien-Dindo), and mortality were analyzed. RESULTS: Ninety-five patients were included (53 female; mean age 74.7 years; 10 [10.5%] aged ≥ 80; 70 [73.7%] ASA III-IV). Commonest primaries: colorectal (40), gastric (14), ovarian (12). Mean PCI was 15.6; complete cytoreduction (CC-0) was achieved in 58.9%. Complications were Clavien-Dindo grade III-IV in 11.6%, and grade V in 3.2%; major morbidity (≥ III) was 14.7%. Longer operative time (p = 0.013) and intraoperative transfusion (p = 0.027) were associated with major morbidity in the elderly cohort, whereas age was not (p = 0.161). Overall mortality was 12/95 (12.6%). CONCLUSIONS: In selected patients aged ≥ 70 years, CRS-HIPEC achieved morbidity and mortality comparable to the younger group, with most complications low-grade. Advanced age alone should not preclude CRS-HIPEC; candidacy depends on comorbidity, performance status, and the likelihood of complete cytoreduction.