Hepatocellular cancer and colorectal liver metastasis treatment in the older population

Abstract

More than 60% of patients with primary and secondary liver tumors are older than 65 years. Thanks to improvements in radiological staging, anesthesia, surgical technique, and perioperative care it is possible to offer complex liver surgery to older patients. However, chronological age or functional status alone should not be a contraindication for multimodal radical treatment in older patients. Fit patients, according to the Comprehensive Geriatric Assessment, should be qualified for the same treatment as younger patients to ensure the same outcomes. Prefrail patients should undergo prehabilitation, and be reevaluated. Frail patients should be discussed in an oncogeriatric meeting. All patients with liver malignant tumors must be operated on in high-volume hospitals by an experienced surgeon. The introduction of parenchymal sparing surgery (instead of a major resection) in combination with other treatment tools, minimal invasive techniques, and enhanced postoperative recovery demonstrated being beneficial for older patients. In particular, frail, older patients can benefit from the wide variety of treatment options.

Liver transplantation in primary liver tumors

“…The degree of malignancy of HEHE is considered to be between that of hemangioma and that of hemangiosarcoma of the liver. Regar-Interestingly, in the last decade recipients over 70 years with end-stage liver disease and HCC have become one of the fastest growing subgroup of patients undergoing liver transplantation [32]. It clearly highlights the progress transplant medicine has made over the years and the role it plays nowadays in cancer treatment.…”

Postoperative functional results of older patients after pancreas and liver surgery

“…In older patients (aged 75 years or older), pathological outcomes and postoperative complications are predictors of survival, whereas pathological outcomes and chemotherapy are predictors of survival in younger population (aged 74 years or less). Thus, prevention of postoperative morbidity may contribute to an improved prognosis for older patients with cancer [6,7]. However, we still need better designed studies on a larger group of patients using frailty evaluations -not only chronological age and comorbidity.…”