Liver resection of colorectal metastases in elderly patients

• Published in: British journal of surgery 2010-03, Vol.97 (3), p.366-376
• Main Authors: Adam, R., Frilling, A., Elias, D., Laurent, C., Ramos, E., Capussotti, L., Poston, G. J., Wicherts, D. A., de Haas, R. J.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Colorectal Neoplasms; Combined Modality Therapy; Disease-Free Survival; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hepatectomy - mortality; Humans; Intraoperative Care; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - surgery; Postoperative Complications - etiology; Postoperative Complications - mortality; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Tumors
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.6889

Background: This study evaluated the outcome of liver surgery for colorectal metastases (CLM) in patients over 70 years old in a large international multicentre cohort. Methods: Among 7764 patients who had resection of CLM, 999 (12·9 per cent) were aged 70–75 years, 468 (6·0 per cent) were aged 75–80 years and 157 (2·0 per cent) were at least 80 years old. Elderly patients were compared with the younger population. Results: Multinodular and bilateral metastases were less common in elderly than in younger patients (P < 0·001). Preoperative chemotherapy was used less frequently and more limited surgery was performed (P < 0·001). Sixty‐day postoperative mortality and morbidity rates were 3·8 and 32·3 per cent respectively, compared with 1·6 and 28·7 per cent in younger patients (both P < 0·001). Three‐year overall survival was 57·1 per cent in elderly and 60·2 per cent in younger patients (P < 0·001), and was similar among patients aged 70–75, 75–80 or at least 80 years (57·8, 55·3 and 54·1 per cent respectively; P = 0·160). Independent predictors of survival were more than three metastases, bilateral metastases, concomitant extrahepatic disease and no postoperative chemotherapy. Conclusion: Liver resection for CLM in elderly patients can achieve a reasonable 3‐year survival rate, with an acceptable morbidity rate. There should be no upper age limit but risk factors may help predict potential benefit. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Age no problem