First and Repeat Resection of Colorectal Liver Metastases in Elderly Patients

Abstract

First and repeat liver resection for colorectal liver metastases can be performed safely in patients older than 70 years. A 5-year survival rate similar to those of younger patients can be expected after first liver resection for patients without the presence of risk factors.

Liver resection of colorectal metastases in elderly patients

“…Moreover, the postoperative mortality rate after repeat hepatectomy was zero, confirming the fact that these patients should not be denied an aggressive surgical approach. These results contrast with the sole publication reporting poorer outcomes for patients who underwent repeat hepatectomy 5 . The mortality rate for repeat resections in the latter study was 7 per cent, with a morbidity rate of 38 per cent.…”

“…The mortality rate for repeat resections in the latter study was 7 per cent, with a morbidity rate of 38 per cent. A 3-year overall survival rate of 25 per cent was reported, with no 5-year survivors from only 14 patients who underwent repeat hepatectomy 5 .…”

The Survival Paradox of Elderly Patients After Major Liver Resections

“…Previous studies addressing this issue have compared cohorts of elderly patients with younger patients treated in the same time period (Table 5). [6][7][8][9][10][11]18 However, comparing cohorts introduces a potential selection bias due to heterogeneity of patients and operative characteristics. In order to maximally reduce selection bias in this study, a matched control analysis was performed to ensure comparison of elderly and younger patients with the same diagnosis and the same extent of liver resection.…”

Experimental Colorectal Cancer Liver Metastasis

“…Another 40-50% of patients will eventually develop liver metastasis during the course of their illness, which is commonly the cause of death (Bentrem, et al, 2005, Stangl, et al, 1994, Sugarbaker, 1990. At present, liver resection is considered the treatment of choice for suited patients with colorectal liver metastases, offering a five-year survival rate of 25-44% (Choti, et al, 2002, Garden, et al, 2006, Zacharias, et al, 2004 to those 20-25% of patients with isolated liver metastasis (Adson, et al, 1984, Bismuth, et al, 1996, Fong, et al, 1999. Unfortunately, this procedure is feasible only in patients with no signs of irresectable extra-hepatic disease, whereas the median survival is only 9-19 months for patients with unresectable disease who receive systemic chemotherapy (de Gramont, et al, 2000, Giacchetti, et al, 2000, Meyerhardt and Mayer, 2005, Saltz, et al, 2000.…”