Abstract
BackgroundFew studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients.MethodsFrom January 2000 to December 2018, 724 patients underwent hepatectomy for colorectal liver-limited metastases. Based on a 1:2 propensity score matching (PSM) model, 64 elderly patients (≥ 70 years of age) were matched to 128 younger patients (< 70 years of age) to obtain two balanced groups with regard to demographic, therapeutic, and prognostic factors.ResultsThere were 73 elderly and 651 younger patients in the unmatched cohort. Compared with the younger group (YG), the elderly group (EG) had significantly higher proportion of American Society of Anesthesiologists score III and comorbidities and lower proportion of more than 3 liver metastases and postoperative chemotherapy (p < 0.05). After PSM for these factors, rat sarcoma virus proto-oncogene/B-Raf proto-oncogene (RAS/BRAF) mutation status and primary tumor sidedness, the EG had significantly less median intraoperative blood loss than the YG (175 ml vs. 200 ml, p = 0.046), a shorter median postoperative hospital stay (8 days vs. 11 days, p = 0.020), and a higher readmission rate (4.7% vs.0%, p = 0.036). The EG also had longer disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS) compared to the YG, but these findings were not statistically significant (p > 0.05). Old age was not an independent factor for DFS, OS, and CSS by Cox multivariate regression analysis (p > 0.05).ConclusionsHepatectomy is safe for colorectal liver-limited metastases in elderly patients, and these patients may subsequently benefit from prolonged DFS, OS, and CSS.
Highlights
Few studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients
A significantly greater proportion of patients had more than 3 liver metastases (31.3% vs. 19.2%, p = 0.032) or received more than six cycles of chemotherapy (13.2% vs 4.1%, p = 0.025) in the younger group (YG) compared to the elderly group (EG)
A greater proportion of patients received postoperative adjuvant chemotherapy in the YG compared to the EG (67.9% versus 54.8%, p = 0.024)
Summary
Few studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients. For the elderly patients who do undergo hepatectomy, there have been conflicting results of studies regarding operation safety and long-term survival [11,12,13,14,15,16,17,18,19]. These studies were not conclusive in part due to biased or missing baseline data, such as comorbidities, the American Society of Anesthesiologists (ASA) score, and preoperative treatment in these studies. To the best of our knowledge, only one study using the propensity score matching method has been published, which demonstrated comparable shortterm and long-term outcomes between the younger group (YG) and the elderly group (EG) [20]
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