The Impact of Advanced Age on Hepatic Resection of Colorectal Liver Metastases

Nagano, Yasuhiko; Nojiri, Kazunori; Matsuo, Keitaro; Tanaka, Kuniya; Togo, Shinji; Ike, Hideyuki; Shimada, Hiroshi

doi:10.1016/j.jamcollsurg.2005.05.010

Cited by 64 publications

(70 citation statements)

References 13 publications

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“…One additional study was included by checking cross references, taking the total number of included studies to 11 [27]. A total number of 4 studies were included comparing patients aged <75 years with patients aged >75 years [12, 28-30].…”

Section: Resultsmentioning

confidence: 99%

“…The weighted mean age of patients aged <70 years was 58.3 ± 7.7 years, whereas the mean age of patients aged >70 years was 73.8 ± 3.2 years. Data regarding comorbidity was reported in about half the studies reviewed [19, 21, 23, 26, 27]. Patients aged <70 years had less cardiovascular comorbidity (12 vs. 36%; p < 0.001), less respiratory comorbidity (8 vs. 18%; p = 0.01), less hypertension (28 vs. 52%; p = 0.04) and less diabetes mellitus (7 vs. 13%; p = 0.02) than patients aged >70 years (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Hospitalization time also varied widely between studies, with one study reporting a mean hospital stay for over 3 weeks [27]. Weighted mean hospital stay in patients aged <70 years was 12.6 ± 11.6 days compared with 13.2 ± 10.7 days for patients aged >70 years ( p = 0.19).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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Background: This systematic review and meta-analysis evaluated the short- and long-term outcomes of liver resection for colorectal liver metastases (CRLM) in elderly patients. Methods: A PubMed, EMBASE, and Cochrane Library search was performed from January 1995 to April 2017, for studies comparing both short- and long-term outcomes in younger and elderly patients undergoing liver resection for CRLM. Results: Eleven studies comparing patients aged <70 years with patients aged >70 years and 4 studies comparing patients aged <75 years with patients aged >75 years were included. Postoperative morbidity was similar in patients aged >70 years (27 vs. 30%; p = 0.35) but higher in patients aged >75 years (21 vs. 32%; p = 0.001). Postoperative mortality was higher in both patients aged >70 years (2 vs. 4%; p = 0.01) and in patients aged >75 years (1 vs. 6%; p = 0.02). Mean 5-year overall survival was lower in patients aged >70 years (40 vs. 32%; p < 0.001) but equal in patients aged >75 years (42 vs. 32%; p = 0.06). Conclusion: Although postoperative morbidity and mortality were increased with higher age, liver resection for CRLM seems justified in selected elderly patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…5 Nevertheless, several observational cohort studies addressed this issue and have failed to show age to be an independent risk factor influencing short-and long-term survival after liver resections. [6][7][8][9][10][11] These observational cohort studies included a mix of wedge, minor, and major liver resections, and retrospectively compared study groups based on patient age at the time of liver resection. This study design may include a selection bias in terms of diagnosis and magnitude of liver resection.…”

Section: Introductionmentioning

confidence: 99%

The Survival Paradox of Elderly Patients After Major Liver Resections

IJtsma

Boevé

Hilst

et al. 2008

Journal of Gastrointestinal Surgery

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Objective The objective of this study is to assess the outcome of liver resections in the elderly in a matched control analysis. Patients and Methods From a prospective single center database of 628 patients, 132 patients were aged 60 years or over and underwent a primary major liver resection. Of these patients, 93 could be matched one-to-one with a control patient, aged less than 60 years, with the same diagnosis and the same type of liver resection. The mean age difference was 16.7 years. Results Patients over 60 years of age had a significantly higher American Society of Anaesthesiologists (ASA) grade. All other demographics and operative characteristics were not different. In-hospital mortality and morbidity were higher in the patients over 60 years of age (11% versus 2%, p=0.017 and 47% versus 31%, p=0.024). One-, 3-, and 5-year survival rates in the patients over 60 years of age were 81%, 58%, and 42%, respectively, compared to 90%, 59%, and 42% in the control patients (p=0.558). Unified model Cox regression analysis showed that resection margin status (hazard ratio 2.51) and ASA grade (hazard ratio 2.26), and not age, were determining factors for survival. Conclusion This finding underlines the important fact that in patient selection for major liver resections, ASA grade is more important than patient age.

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