title: Liver resection for metastases from colorectal cancer in very elderly patients: New surgical horizons.
abstract: OBJECTIVE
  Patients with colorectal cancer (CRC) may develop liver metastases. Surgical resection remains the best treatment of choice for colorectal liver metastases (CRLM) according to resectability criteria, with a long-term survival of 25% up to 41% after 5 years. Advanced age is associated with a higher incidence and co-morbidity, particularly cardiovascular disease, as well as deteriorating physiological reserves. The aim of this study was to analyse the overall and disease-free survival for patients with CRLM according to their chronological age.
  
  
  METHODS
  Patients with CRLM were enrolled in the study. Data on gender, age, co-morbidity, metastasis characteristics (number, size and total metastatic volume (TMV)), use of perioperative chemotherapy and operative and post-operative complications were collected. Then, according to recent World Health Organization (WHO) guidelines, the patients were grouped by age. Statistical analysis was performed using the software R (ver. 2.14.1).
  
  
  RESULTS
  Hepatic resection was performed in 149 patients (21 patients in the very elderly group, 79 in the elderly group and 49 in the younger group). The three groups were comparable in terms of operative duration, transfusion rate, length of high-dependency unit (HDU) stay and post-operative hospital stay. The very elderly group showed a non-significant increase in post-operative morbidity. The 30-day and 60-day/inpatient mortality rates increased with age without any significant statistically difference between the three groups (very elderly group 4.8% and 4.8%; elderly group: 2.5% and 3.8%; and younger group 0% and 2%). At 5 years, the overall survival was 28.6% for very elderly patients (≥75 years), 33.3% for elderly patients (≥65 to <75 years) and 43.5% for younger patients (≤65 years). The 1-, 3- and 5-year disease-free survival was similar across the groups.
  
  
  CONCLUSIONS
  Liver resection for CRLM in carefully selected patients above the age of 75 can be performed with acceptable morbidity and mortality rates, similar to those in younger patients. Moreover, the severity of CRLM in elderly patients is proven to be lesser than in younger patients. Thus, we can conclude that advanced chronological age cannot be considered a contraindication to hepatic resection for CRLM.
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy. Electronic address: Bruno.nardo@unibo.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Nardo
authors.affiliation: Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy. Electronic address: seraf87@gmail.com.
authors.forename: Simone
authors.initials: S
authors.lastname: Serafini
authors.affiliation: Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy. Electronic address: ruggant@alice.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Ruggiero
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Italy. Electronic address: raffaele.eia@alice.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Grande
authors.affiliation: Department of Medical and Surgical Science, University of Modena, Italy. Electronic address: francescofugetto@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fugetto
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Italy. Electronic address: alessandra.zullo@gmail.com.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Zullo
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy. Electronic address: matteo.novello@studio.unibo.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Novello
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Italy. Electronic address: arizzuto@unicz.it.
authors.forename: Antonia
authors.initials: A
authors.lastname: Rizzuto
authors.affiliation: Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy. Electronic address: bonaiutoelisabetta@gmail.com.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bonaiuto
authors.affiliation: Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy. Electronic address: s.vaccarisi@libero.it.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Vaccarisi
authors.affiliation: Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of Bologna, Italy. Electronic address: giuseppe.cavallari3@unibo.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallari
authors.affiliation: Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of Bologna, Italy. Electronic address: rserra@unicz.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Serra
authors.affiliation: Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy. Electronic address: anubis_m@libero.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Cannistrà
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Italy. Electronic address: sacco@unicz.it.
authors.forename: Rosario
authors.initials: R
authors.lastname: Sacco
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D016330:Frail Elderly; D006299:Health Services for the Aged; D006498:Hepatectomy; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Colorectal metastases; Elderly; Liver resection; Prognostic factors; Survival