Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile?
BACKGROUND
The elderly are under-represented in series of patients operated on for colorectal liver metastases (LM).


OBJECTIVE
To analyse the influence of age on surgery of colorectal LM, and the identification of factors that could be used as exclusion criteria.


METHODS
Six hundred and forty-eight patients underwent liver resection between 1990 and 2006. Demographic data, primary tumour related variables, stage of the disease, morbidity, mortality, survival and recurrence were prospectively recorded.


RESULTS
One hundred and sixty of 648 patients (25%) were 70 years old or older. Postoperative mortality was significantly higher in elderly patients (8% vs. 3%, p=0.008). Morbidity was also higher (41% vs. 34%, p=0.008). Survival rate at 1, 3 and 5 years was 88%, 62% and 45% respectively in patients younger than 70 years, and 82%, 48% and 36% in the elderly (p=0.007). Excluding the postoperative mortality, the figures were 90%, 64% and 46%. 90%, 53% and 38% (p=0.061). Disease-free survival rates at 1, 3 and 5 years excluding postoperative mortality were 68%, 32% and 25% in younger patients, compared to 68%, 34% and 30% (p=0.71) in the elderly. Major liver resections increased mortality in the elderly. In the multivariate analyses only a tumour size equal to or more than 10 cm significantly increased the postoperative mortality risk in elderly patients.


CONCLUSIONS
The elderly have a higher mortality. In recent years that difference has been markedly reduced. Excluding the postoperative mortality, the overall survival and disease-free survival are similar between both groups. The criteria to indicate surgery must be the same in both groups.
Figueras
J
J
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Hospital Josep Trueta, Girona, Spain. info@jfigueras.net
Ramos
E
E
López-Ben
S
S
Torras
J
J
Albiol
M
M
Llado
L
L
González
H D
HD
Rafecas
A
A
D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate