Hepatic resection for malignant liver tumours in the elderly: a systematic review and meta‐analysis

Abstract

Background: The number of elderly patients undergoing hepatic resection for surgical treatment of benign and malignant cancers is increasing. However, there is limited clinical data on the complications and long-term survival rates associated with liver surgery in the elderly patients (≥70 years) versus younger patients for malignant liver conditions. Methods: Six electronic databases were searched for original published studies comparing elderly (≥70) versus younger (<70) cohorts for malignant liver tumours. Data were extracted and analysed according to predefined clinical endpoints. Results: Twenty-seven comparative studies were identified, including 4769 elderly patients versus 15 855 younger patients (n = 20 624). There was significantly higher 30-day mortality in the elderly colorectal liver metastasis group (P < 0.00002) and significant difference between elderly and young in terms of overall survival (hazard ration (HR), 1.10; P = 0.02). However, there was no difference in disease-free survival (HR, 1.05; P = 0.27). Post-operative pneumonia, renal failure and infection were more frequent in the elderly group. Conclusions: Liver resection for malignant hepatic tumours in the elderly is associated with a greater 30-day mortality and overall mortality when compared with younger cohorts, but similar disease-free survival. Length of stay and transfusions were not significantly different while pneumonia, renal failure and infections were more frequent in the elderly group.

Systematic Review and Meta-Analysis of Liver Resection for Colorectal Metastases in Elderly Patients

“…Another recent meta-analysis combining both CRLM as HCC and other malignant liver tumours showed higher mortality for elderly patients but comparable disease-free survival. As for the different malignancies, these results are difficult to interpret for patients who undergo liver resection for CRLM [14]. Therefore, this meta-analysis analyses both short- and long-term outcomes for patients who undergo liver resection for CRLM, as both outcomes are relevant for careful decision making.…”

“…Recent systematic reviews and meta-analysis focussed only on short-term outcomes [13] and combined patients for both CRLM and hepatocellular carcinoma (HCC) [14]. As of a different biological behaviour of HCC compared with CRLM and the importance for long-term results in large populations, a meta-analysis for solely CRLM studying both short- and long-term outcomes will add to more careful decision making in elderly patients affected by CRLM.…”

Short‐ and long‐term outcomes of elderly patients undergoing liver resection for colorectal liver metastasis

“…Significantly higher mortality rates of 4.8% and severe complication rates of 24% were observed, despite lesser resections being performed in the elderly. A recent systematic review and meta‐analysis concluded that liver resection, in patients over 70, was associated with greater mortality and major complications, but that disease‐free survival was equivalent . This paper highlights the issues with meta‐analysis from heterogenous uncontrolled data sets, often compiled from a range of high and low volume units and over a 35‐year period, which is not representative of modern liver surgery.…”

“…A recent systematic review and meta-analysis concluded that liver resection, in patients over 70, was associated with greater mortality and major complications, but that disease-free survival was equivalent. 27 This paper highlights the issues with meta-analysis from heterogenous uncontrolled data sets, often compiled from a range of high and low volume units and over a 35-year period, which is not representative of modern liver surgery. Conversely in our current study of older patients (using a methodology lower on the evidence based medicine pyramid) from a high volume centre, a high proportion of major resections and a high proportion of patients receiving neoadjuvant chemotherapy, is externally valid to nearly all centres performing liver resection in Australia and around the world.…”

High Serum CA19-9 Concentration Predicts Poor Prognosis in Elderly Patients with Stage IV Colorectal Cancer

“…In elderly patients, aggressive curative resection might yield the benefit of improving OS similar to that of younger patients. However, some studies reported that hepatic or pulmonary resection yielded higher mortality and complication rates in elderly compared to younger patients [26, 27]. Therefore, the operative indications for distant metastasis must be carefully decided upon in elderly patients with stage IV CRC.…”