Liver resection for metastases from colorectal cancer in very elderly patients: New surgical horizons

Nardo, Bruno; Serafini, Simone; Ruggiero, Michele; Grande, Raffaele; Fugetto, Francesco; Zullo, Alessandra; Novello, Matteo; Rizzuto, Antonia; Bonaiuto, Emanuela; Vaccarisi, S.; Cavallari, Giuseppe; Serra, Raffaele; Cannistrà, Marco; Sacco, Rosario

doi:10.1016/j.ijsu.2016.06.014

Cited by 25 publications

(35 citation statements)

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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]. The characteristics of each study are given in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The weighted mean age of patients aged <75 years was 61.5 ± 6.7 years, whereas the weighted mean age of patients aged >75 years was 77.6 ± 1.6 years. Only 2 studies reported on comorbidity [28, 30], which showed that patients aged >75 years were affected more often by cardiovascular comorbidity (33 vs. 20%; p = 0.03). There was no difference in respiratory comorbidity (7 vs. 4%; p = 0.58) and diabetes mellitus (15 vs. 9%; p = 0.19) compared with patients aged <75 years (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Overall postoperative morbidity was reported by 3 studies [12, 28, 30]. The weighted morbidity was 21% for patients aged <75 years compared with 32% for patients aged >75 years ( p = 0.001; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Postoperative mortality was defined as mortality within 30 days by 3 studies [28-30] and within 90 days by 1 study [12]. The weighted postoperative mortality for all studies was 1% for patients aged <75 years compared with 6% in patients aged >75 years ( p = 0.02; Table 5; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…3c). Only 2 studies reported 5-year disease-free survival [28, 30]. The weighted 5-year disease-free survival was 41% for patients aged <75 years compared with 39% for patients aged >75 years ( p = 0.16).…”

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%

Section: Resultsmentioning

confidence: 99%

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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Outcomes of simultaneous resection for elderly patients with colorectal liver metastasis: A propensity score matching analysis

et al. 2022

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Background Evidence on simultaneous resection for elderly patients (age ≥ 70 years) with colorectal liver metastasis (CRLM) is lacking. Methods Four hundred and eighty‐two CRLM patients treated by simultaneous resection were categorised into young group (age < 70 years) and elderly group (age ≥ 70 years). Propensity score matching (PSM1) was performed to adjust for differences in baseline characteristics and compare short‐term outcomes. An additional propensity score matching (PSM2) including short‐term outcomes was performed to analyse survival. Subgroup analysis was performed in patients stratified by the Clinical Risk Score (CRS). Results After PSM1, 87 young group patients were matched to 50 elderly group patients. Patients in the elderly group had a significantly higher rate of overall post‐operative complications (68.0% vs. 46.0%, p = 0.013). After PSM2, 89 young group patients were matched to 47 elderly group patients. Progression‐free survival (PFS) was comparable between the two groups (median 11.0 months vs. 9.8 months, p = 0.346). Age ≥ 70 independently predicted worse overall survival (OS) (Hazard ratio, HR = 2.57, 95% confidence interval, CI 1.37–4.82) in multivariate analysis. In the subgroup multivariate analysis of patients with CRS score 3–5, age ≥ 70 was independently associated with worse PFS (HR = 1.62, 95% CI 1.01–2.62) and OS (HR = 2.34, 95% CI 1.26–4.35). Conclusions Simultaneous resection for elderly CRLM patients is acceptable. Further studies are required to determine the optimal treatment for elderly CRLM patients with high CRS scores.

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Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?

Neuwirth

Bierema

Sinnamon

et al. 2017

Cancer

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BACKGROUND:Although there is a general perception that, as the older population grows in number, more are undergoing surgery, there are few data on trends in major resections for cancer and short-term outcomes in this group. METHODS: The Nationwide Inpatient Sample was (NIS) used to estimate the national trends of major upper abdominal resections (esophagus, stomach, liver, pancreas) for cancer in octogenarians (aged 80 years) from 2001 to 2011. Resection rates performed per year were incidence-adjusted within this age group for each cancer type as determined by the NIS database. Joinpoint regression was used to calculate average annual percentage changes (AAPC) when evaluating trends over time. RESULTS: During the study period, octogenarians underwent an estimated 30,356 upper abdominal organ resections for cancer in the United States, representing 3.8% of all cancer admissions among octogenarians. Resection rates in octogenarians increased significantly over time (AAPC, 2.54; P < .001) secondary to increasing trends in pancreatic (AAPC, 11.52; P < .001) and hepatic (AAPC, 6.67; P < .001) resections. Elixhauser comorbidity index scores increased from a mean of 3.61 to 4.20 (AAPC, 1.31; P < .001), whereas inpatient mortality during this time decreased from 13.6% to 8.2% (AAPC, 5.58; P < .001). CONCLUSIONS: Overall rates of major upper abdominal cancer resections in octogenarians are increasing over time, driven by increases in liver and pancreatic resections. These increases were observed despite a less favorable patient morbidity profile over time. These patterns may suggest shifting selection criteria for octogenarians undergoing major abdominal surgery over time in the context of diminishing postoperative mortality. Cancer 2018;124:125-35. V C 2017 American Cancer Society.KEYWORDS: abdominal surgery, gastrointestinal cancer, national trends, octogenarian, outcomes. INTRODUCTIONOctogenarians (patients ages 80 years) have traditionally been considered at higher risk for major surgical procedures, including various types of cancer resections. This particular population is growing rapidly, with current forecasts estimating an increase in the population aged 85 years older from 1.7% of the population (5.4 million individuals) in 2008 to 7.5% of the population (projected, 27-35 million individuals) by 2050. 1 Likewise, it is estimated that adults aged 75 will increase from 18.7 million (6.1%) in 2010 to a projected 33.3 million (11%) by 2030. 2 The older population is also at the higher risk of developing cancer, with 60% of new diagnoses of malignancies occurring in those aged 65 years. 3,4 However, data reporting specific trends and outcomes in octogenarians with regard to major abdominal operations for cancer are relatively lacking. Characterization of such trends may be particularly important to help identify changes in selection criteria for surgery in this growing older adult population.Several recent studies have demonstrated similar postoperative outcomes in older adult patients compared with younger cohort...

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Liver resection for metastases from colorectal cancer in very elderly patients: New surgical horizons

Cited by 25 publications

References 52 publications

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

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

Outcomes of simultaneous resection for elderly patients with colorectal liver metastasis: A propensity score matching analysis

Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?

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