Changing outlook for colorectal liver metastasis resection in the elderly

Tufo, Andrea; Dunne, Declan; Manu, Nichola; Lacasia, C.; Jones, Louise; Carino, Nicola de Liguori; Malik, Hassan; Poston, Graeme J.; Fenwick, Stephen

doi:10.1016/j.ejso.2018.11.024

Cited by 22 publications

(16 citation statements)

References 30 publications

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“…Given the increasing aged surgical population, it is not surprising that the number of elderly patients undergoing hepatic resection for treatment of liver cancer is progressively increasing. Tufo and colleagues [15] showed that the number of patients who underwent liver resection older than 70 years raised from 6% of 1990 to > 25% in 2007. Although several studies have examined the feasibility of hepatic resection for colorectal liver metastasis (CRLM), intrahepatic cholangiocarcinoma (ICC), and hepatocarcinoma (HCC) among elderly patients [8][9][10][15][16][17][18][19], the results were disparate.…”

Section: Discussionmentioning

confidence: 99%

Major hepatectomy for perihilar cholangiocarcinoma in elderly patients: is it reasonable?

et al. 2021

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Introduction We sought to evaluate the effect of age on postoperative outcomes among patients undergoing major liver surgery for perihilar cholangiocarcinoma (PHCC). Methods 77 patients were included. Patients were categorized into two groups: the “< 70-year-olds” group (n = 54) and the “≥ 70-year-olds” group (n = 23). Results Median LOS was 19 both for < 70-year-old group and ≥ 70-year-old group (P = 0.72). No differences in terms of severe complication were detected (44.4% Clavien–Dindo 3–4–5 in < 70-year-old group vs 47.8% in ≥ 70-year-old group, P = 0.60). Within 90 postoperative days, 11 patients died, 6 in < 70-year-old group (11.3%) and 5 in ≥ 70-year-old group (21.7%), P = 0.29. The median follow‐up was 20 months. The death rate was 72.2% and 78.3% among patients < 70 years old and ≥ 70 years old. The OS at 2 and 5 years was significantly higher among the < 70 years old (57.0% and 27.7%) compared to the ≥ 70 years old (27.1% and 13.6%), P = 0.043. Adjusting for hypertension and Charlson comorbidity index in a multivariate analysis, the HR for age was 1.93 (95% CI 0.84–4.44), P = 0.12. Relapse occurred in 43 (81.1%) patients in the < 70-year-old group and in 19 (82.6%) patients in the ≥ 70-year-old group. DFS at 12, 24, and 36 months was, respectively, 59.6, 34.2, and 23.2 for the < 70 -year-old group and 32.5, 20.3, and 13.5 for the ≥ 70-year-old group (P = 0.26). Adjusting for hypertension and Charlson comorbidity index in a Cox model, the HR for age was 1.52 (95% CI 0.67–3.46), with P = 0.32. Conclusions ≥ 70-year-old patients with PHCC can still be eligible for major liver resection with acceptable complication rates and should not be precluded a priori from a radical treatment.

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Section: Discussionmentioning

confidence: 99%

Major hepatectomy for perihilar cholangiocarcinoma in elderly patients: is it reasonable?

et al. 2021

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“…There are different de nitions in the literature as to the cutoff age for an individual to be designated as elderly [11,[15][16][17][18]20]. However, the most frequently used cutoff age is 70 [15,16,[21][22][23], which was adopted for the EG cutoff in this study. Due to the unmatched demographic and preoperative treatment data between the EG and the YG in this study, a PSM method was used to probe the effect of age on patient outcomes after hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Liver Resection for Colorectal Liver-limited Metastases in Elderly Patients: A Propensity Score Matching Analysis

Jin

Wang

Bao

et al. 2020

Preprint

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Background: Few studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients. Methods: From January 2000 to December 2018, 724 patients underwent hepatectomy for colorectal liver-limited metastases. Based on a 1:2 propensity score matching (PSM) model, 64 elderly patients (≥70 years of age) were matched to 128 younger patients (＜70 years of age) to obtain two balanced groups with regards to demographic, therapeutic and prognostic factors.Results: There were 73 elderly and 651 younger patients in the unmatched cohort. Compared with the younger group (YG), the elderly group (EG) had significantly higher proportion of American Society of Anesthesiologists score Ⅲ and comorbidities, and lower proportion of more than 3 liver metastases and postoperative chemotherapy (p<0.05). After PSM for these factors, rat sarcoma virus proto-oncogene/B-Raf proto-oncogene (RAS/BRAF) mutation status and primary tumor sidedness, the EG had significantly less median intraoperative blood loss than the YG (175ml vs. 200ml, p=0.046), a shorter median postoperative hospital stay (8 days vs. 11 days, p=0.020) and a higher readmission rate (4.7% vs.0%, p=0.036). The EG also had longer disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) compared to the YG, but these findings were not statistically significant (p>0.05). Old age was not an independent factor for DFS, OS and CSS by Cox multivariate regression analysis (p>0.05). Conclusions: Hepatectomy is safe for colorectal liver-limited metastases in elderly patients, and these patients may subsequently benefit from prolonged DFS, OS and CSS.

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“…There are different de nitions in the literature as to the cutoff age for an individual to be designated as elderly [11,[15][16][17][18]20]. However, the most frequently used cutoff age is 70 [15,16,[22][23][24], which was adopted for the EG cutoff in this study. Due to the unmatched demographic and preoperative treatment data between the EG and the YG in this study, a PSM method was used to probe the effect of age on patient outcomes after hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

“…However, with the aging of the global population, an increasing number of patients are being diagnosed at an elderly age, when resection may not be a viable treatment option due to a patient's poor performance status or comorbidities [10]. For the elderly patients who do undergo hepatectomy, there have been con icting results of studies regarding operation safety and long-term survival [11][12][13][14][15][16][17][18][19]. These studies were not conclusive in part due to biased or missing baseline data, such as comorbidities, the American Society of Anesthesiologists (ASA) score, and preoperative treatment in these studies.…”

Section: Introductionmentioning

confidence: 99%

Liver Resection for Colorectal Liver-limited Metastases in Elderly Patients: A Propensity Score Matching Analysis

Jin

Wang

Bao

et al. 2020

Preprint

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Background: Few studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients.Methods: From January 2000 to December 2018, 724 patients underwent hepatectomy for colorectal liver-limited metastases. Based on a 1:2 propensity score matching (PSM) model, 64 elderly patients (≥70 years of age) were matched to 128 younger patients (＜70 years of age) to obtain two balanced groups with regards to demographic, therapeutic and prognostic factors.Results: There were 73 elderly and 651 younger patients in the unmatched cohort. Compared with the younger group (YG), the elderly group (EG) had significantly higher proportion of American Society of Anesthesiologists score Ⅲ and comorbidities, and lower proportion of more than 3 liver metastases and postoperative chemotherapy (p<0.05). After PSM for these factors, rat sarcoma virus proto-oncogene/B-Raf proto-oncogene (RAS/BRAF) mutation status and primary tumor sidedness, the EG had significantly less median intraoperative blood loss than the YG (175ml vs. 200ml, p=0.046), a shorter median postoperative hospital stay (8 days vs. 11 days, p=0.020) and a higher readmission rate (4.7% vs.0%, p=0.036). The EG also had longer disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) compared to the YG, but these findings were not statistically significant (p>0.05). Old age was not an independent factor for DFS, OS and CSS by Cox multivariate regression analysis (p>0.05).Conclusions: Hepatectomy is safe for colorectal liver-limited metastases in elderly patients, and these patients may subsequently benefit from prolonged DFS, OS and CSS.

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Changing outlook for colorectal liver metastasis resection in the elderly

Cited by 22 publications

References 30 publications

Major hepatectomy for perihilar cholangiocarcinoma in elderly patients: is it reasonable?

Major hepatectomy for perihilar cholangiocarcinoma in elderly patients: is it reasonable?

Liver Resection for Colorectal Liver-limited Metastases in Elderly Patients: A Propensity Score Matching Analysis

Liver Resection for Colorectal Liver-limited Metastases in Elderly Patients: A Propensity Score Matching Analysis

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