Abstract
BackgroundLimited data describe the therapeutic practice and outcomes of colorectal liver metastases (CRLMs) in elderly patients. We aimed to evaluate the impact of age on multidisciplinary treatment for CRLMs.MethodsWe reviewed treatment and outcomes for patients in different age groups who underwent initial hepatectomy for CRLMs from 2004 through 2012.ResultsWe studied 462 patients who were divided into three groups by age: ≤ 64 years (n = 265), 65–74 years (n = 151), and ≥ 75 years (n = 46). The rate of major hepatectomy and incidence of postoperative complications did not differ between groups. Adjuvant chemotherapy was used less in the ≥ 75-year group (19.6%) than that in the ≤ 64 (54.3%) or 65–74 age group (43.5%). Repeat hepatectomy for liver recurrence was performed less in the ≥ 75-year group (35%) than in the ≤ 64 (57%) or 65–74 (66%) age group. The 5-year disease-specific survival (DSS) rate of 44.2% in the ≥ 75-year group was lower than in the ≤ 64 (59.0%) or 65–74 (64.7%) age group. Multivariate analysis revealed age ≥ 75 years was an independent predictor of poor DSS.ConclusionsLiver resection for CRLMs can be performed safely in elderly patients. However, repeat resection for recurrence are performed less frequently in the elderly, which may lead to the poorer disease-specific prognosis.
Highlights
With the rapid aging of the society, medical services for elderly patients have become more important in many developed countries
We examined the safety of initial hepatectomy, the prevalence of perioperative chemotherapy, recurrence pattern after initial hepatectomy, and the prevalence of repeat resection for the recurrence, in relation to the age
The study revealed that cancer-related survival in patients ≥ 75 years was significantly impaired, which may have been caused by the lower rate of repeat hepatectomy for liver recurrence in the older patients
Summary
With the rapid aging of the society, medical services for elderly patients have become more important in many developed countries. In Japan, the prevalence of colorectal cancer has continued to increase with the development of a super-aging society in which the population of those ≥ 65 years exceeds 21%, while the age-adjusted incidence rate of colorectal cancer has not changed [1,2,3]. Surgical treatment alone is not enough, and a multidisciplinary approach including repeat resection is indispensable to achieve improved outcome for the treatment for CRLMs. Perioperative chemotherapy improves recurrence-free survival (RFS) in patients with CRLMs [18, 19], and aggressive repeat hepatectomy is an important option because the first relapse after initial hepatectomy does not reflect cancer-related survival in patients with CRLMs [20,21,22,23]. Limited data describe the therapeutic practice and outcomes of colorectal liver metastases (CRLMs) in elderly patients. We aimed to evaluate the impact of age on multidisciplinary treatment for CRLMs
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