Hepatectomy for octogenarians with colorectal liver metastasis in the era of enhanced recovery

Tufo, Andrea; Dunne, Declan; Manu, Nichola; Joshi, Heman; Lacasia, C.; Jones, Louise; Malik, Hassan; Poston, Graeme J.; Fenwick, Stephen

doi:10.1016/j.ejso.2018.01.089

Cited by 22 publications

(16 citation statements)

References 29 publications

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“…The in the literature reported median hospital stays after hepatic resection (HR) in older patients range from 11 to 12 days and is substantially longer (19–21). This however, has been reported to be a median of 6 days for octogenarians undergoing HR in programs using enhanced recovery after surgery (22). The importance of the length of hospitalization is emphasized by the fact, that older patients show a significant decline of functional status which is directly related to the length of hospitalization (23).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiofrequency Ablation of Liver Tumors in Octogenarians

et al. 2019

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Purpose: This study aimed to evaluate the efficacy and overall clinical outcome of patients over the age of 80 undergoing stereotactic radiofrequency ablation (SRFA) and to compare the results to a younger population with propensity score matching.Materials and Methods: Between 2006 and 2018 36 patients aged between 80 and 90 years underwent 46 SRFA sessions of 70 primary and secondary liver tumors. For comparison of treatment safety and efficacy 36 younger patients were selected with propensity score matching by the R package “MatchIt” in this retrospective, single-center study.Results: 68/70 tumors were successfully ablated at first ablation session (97% primary technical efficacy rate). Local tumor recurrence developed in 5 of 70 nodules (7.1%). The complication rate above Clavien-Dindo Grade III was 6.5% (3 of 46). The overall survival (OS) rates at 1-, 3-, and 5- years from the date of the first SRFA were 84.6, 50.5, and 37.9% for HCC patients and 87.5%, 52.5% at 1-, and 3-years for CRC patients. The disease-free survival (DFS) for HCC patients after SRFA was 79.1, 35.6, and 23.7%, at 1-, 3-, and 5- years, and 75%, 22.5% at 1-, and 3-years for CRC patients. There were no significant differences in terms of technical efficacy, local recurrences, major complications, OS and DFS compared to the control group.Conclusion: SRFA in octogenarians is a safe, feasible and useful option in the management of primary or metastatic liver tumors with no significant difference in outcomes compared to a younger control group.

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Section: Discussionmentioning

confidence: 99%

Stereotactic Radiofrequency Ablation of Liver Tumors in Octogenarians

et al. 2019

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“…However, octogenarians were at higher risk of sustaining post-operative delirium, cardiovascular events and ileus. A further recent publication by Tufo et al 4 explores the use of cardiopulmonary exercise testing and an enhanced recovery after surgery protocol in octogenarians undergoing liver resection. Their results mirror the Hamburg and Adelaide experience.…”

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confidence: 99%

Liver resection in octogenarians: are the outcomes worth the risk? The Hamburg Barmbek experience

Makridis

Reese

Kantas

et al. 2019

ANZ Journal of Surgery

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“…Concerning elderly patients, only 6 cases (10%) of octogenarians (patients aged >80) were treated curatively in our cohort, possibly representing a specific subgroup with potential for further increase of curative resection rates. However, available studies on the safety of liver resections for CRLM in octogenarians report conflicting results with partly significantly increased morbidity and mortality, most certainly demonstrating the need for strict preoperative risk assessment, for example with cardiopulmonary-exercise testing (CPET) [52,53].…”

Section: Discussionmentioning

confidence: 99%

Progressive Oncological Surgery Is Associated with Increased Curative Resection Rates and Improved Survival in Metastatic Colorectal Cancer

Primavesi

Stättner

Jäger

et al. 2019

Cancers

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Background: Secondary resection rates in first-line chemotherapy trials for metastatic colorectal cancer (mCRC) remain below 15%, representing a clear contrast to reports by specialised surgical centres, where progressive liver, peritoneal-surface, and pulmonary surgery increased access to curative-intent treatment. We present a long-term evaluation of oncosurgical management in a single-centre, analysing the aggregate effect of gradual implementation of surgical subspecialties and systemic treatments on mCRC patients’ resection rates and prognosis. Methods: Patients with newly diagnosed mCRC from 2003 to 2014 were retrospectively categorised into palliative treatment (PAT) and curative intent surgery (CIS) and three time periods were analysed for treatment changes and factors associated with survival. Results: Four hundred-twenty patients were treated (PAT:250/CIS:170). Over time periods, the number of presenting patients remained consistent, whereas curative resection rates increased from 29% to 55%, facilitated by an increment of patients undergoing hepatectomy (21 to 35%), pulmonary surgery (6 to 17%), and peritonectomy/intraoperative chemotherapy (0 to 8%). Also, recently, significantly more multi-line systemic treatments were applied. The median survival markedly improved from 21.9 months (2003–2006; 95% confidence interval (CI) 17.3–26.5) to 36.5 months (2011–2014; 95% CI 26.6–46.4; p = 0.018). PAT was a significant factor of poor survival and diagnosis of mCRC in the latest time period was independently associated with a distinctly lower risk for palliative treatment (odds ratio 0.15). Conclusions: In modern eras of medical oncology, achieving appropriate resection rates through utilization of state-of-the-art oncological surgery by dedicated experts represents a cornerstone for long-term survival in mCRC.

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Hepatectomy for octogenarians with colorectal liver metastasis in the era of enhanced recovery

Cited by 22 publications

References 29 publications

Stereotactic Radiofrequency Ablation of Liver Tumors in Octogenarians

Stereotactic Radiofrequency Ablation of Liver Tumors in Octogenarians

Liver resection in octogenarians: are the outcomes worth the risk? The Hamburg Barmbek experience

Progressive Oncological Surgery Is Associated with Increased Curative Resection Rates and Improved Survival in Metastatic Colorectal Cancer

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