Perioperative outcomes of CRS-HIPEC in older versus younger patients with ovarian cancer: the role of frailty

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) has emerged as an important treatment modality for selected patients with ovarian, tubal, and primary peritoneal carcinomas. Despite increasing evidence supporting its oncological benefit, one of the major counter-arguments is the possible morbidity and mortality associated with HIPEC, particularly in a population that is often older and vulnerable. 

Methods: This retrospective cohort study evaluates postoperative morbidity and mortality in patients aged ≥70 years who underwent CRS plus HIPEC for epithelial ovarian cancer (EOC) at our center since 2018. Vulnerability was assessed using the G8 geriatric screening tool. A complicated postoperative course was defined as 30-day mortality, prolonged hospitalization (>30 days), or readmission within 30 days. 24 women aged ≥70 years (mean age 76; mean G8 score 14.1) were included; 10 of them were classified as vulnerable (G8 ≤14). Outcomes were compared with fit older patients (G8 >15) and a younger control group (<70 years; n=26; mean age 57). Proportions were compared using Fisher’s Exact test.

Results: Our results suggest a significantly higher rate of complicated postoperative courses in vulnerable patients (4/10) compared with fit older patients (1/14) and younger controls (1/26), corresponding to 40% (4/10) vs 0.05% (2/40) (p = 0.02; OR 8.0; 95%CI [1.28, 50.04]).

Conclusions: Vulnerability, as assessed by the G8 score, appears more predictive of postoperative complications after CRS plus HIPEC than chronological age alone. Incorporating frailty screening into preoperative evaluation may improve patient selection and risk stratification for this intensive treatment modality.