Laparoscopic Cytoreductive Surgery with HIPEC in a Woman Over 90: A Remarkable Success in Jordan

A multidisciplinary surgical team led by Dr. Osama Hamed successfully performed laparoscopic cytoreductive surgery with HIPEC on a woman over 90 years old who had limited peritoneal metastases from mucinous colon adenocarcinoma. This case represents one of the more advanced examples of abdominal oncology surgery, requiring careful patient selection, complete cytoreduction, and expertise in heated intraperitoneal chemotherapy.

Although the patient was of very advanced age, she maintained excellent functional status and full independence in daily life, making her a suitable candidate for advanced surgery rather than palliative-only care.

Preoperative Assessment

The patient had a previous history of colon cancer resection, followed by recurrent disease presenting as limited peritoneal spread that did not respond adequately to intravenous chemotherapy. Preoperative imaging and surgical assessment showed involvement of the right hemidiaphragm, pelvic peritoneum, omentum, uterus, left ovary, and a few small nodules on the mesentery.

During exploration, the peritoneal cancer index (PCI) was estimated at approximately 7–9, indicating a relatively limited disease burden that could be approached with complete cytoreduction. Importantly, there was no extensive involvement of the small or large bowel, which is a key factor in determining whether CRS and HIPEC can be performed successfully.

Details of the Surgical Procedure

The operation was performed entirely laparoscopically under general anesthesia. A thorough exploration of the abdomen confirmed limited peritoneal disease centered mainly in the right hemidiaphragm, pelvis, uterus, and a large cystic mass in the left ovary.

A complete cytoreductive surgery was then carried out, including:

• Resection of the diaphragmatic peritoneum.

• Removal of peritoneal and mesenteric tumor nodules.

• Omentectomy.

• Cholecystectomy.

• Hysterectomy with bilateral salpingo-oophorectomy.

• Resection of pelvic peritoneum.

After completion of cytoreduction, HIPEC was initiated using mitomycin in sequential doses. This combined approach aims to remove visible disease surgically and treat microscopic residual cancer cells with heated chemotherapy delivered directly into the abdominal cavity.

Why This Case Is Remarkable

This case is particularly notable because CRS and HIPEC in a patient over 90 years old is rare and requires more than age-based decision-making. The most important considerations are functional status, disease burden, and the likelihood of achieving complete cytoreduction.

The laparoscopic approach adds another important dimension. In selected patients, laparoscopic CRS and HIPEC may offer less pain, reduced blood loss, faster recovery, and fewer wound-related complications. For an elderly patient, these benefits can be especially valuable.

This case highlights the value of a highly experienced multidisciplinary team involving surgical oncology, anesthesia, medical oncology, and gynecology. It also demonstrates that advanced peritoneal surface malignancy surgery can be performed in Jordan at a high international standard when the right patient is selected.

Postoperative Follow-Up

Following surgery, the patient requires close follow-up with the surgical and oncology teams to monitor recovery, bowel function, nutritional status, and early complications. Regular postoperative visits, imaging, and clinical review are important to guide further management and detect recurrence at an early stage if it occurs.

Successful surgery does not end in the operating room. It continues through structured recovery, surveillance, and supportive care designed to protect long-term outcomes.

Watch The Case Video:
Laparoscopic CRS with HIPEC

Another HIPEC Surgery: 

HIPEC Surgery — Advanced Intraperitoneal Chemotherapy for Complex Abdominal Tumors

Conclusion

This case shows that laparoscopic cytoreductive surgery with HIPEC can be a valid advanced treatment option even in very elderly patients, provided the disease is limited and the patient is carefully selected. It also underscores the importance of teamwork, precision surgery, and individualized oncologic decision-making in achieving the best possible outcome.