Liver resection of colorectal metastases in elderly patients

Adam, R.; Frilling, Andrea; Élias, Dominique; Laurent, Alexis; Ramos, Emilio; Capussotti, Lorenzo; Poston, Graeme J.; Wicherts, Dennis A.; Haas, Robbert J. de

doi:10.1002/bjs.6889

Cited by 224 publications

(210 citation statements)

References 26 publications

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“…The majority of the panel (14/15, 93%) agreed that synchronicity is a sign of poor prognosis, irrespective of the treatment. In the ongoing LiverMetSurvey international registry, an international registry of patients undergoing surgery for CRCLM, [20], available current data show a significant difference in survival when metastases are detected at or 1 month before diagnosis vs 0-3 months after diagnosis (p < 0.0001); 5-year survival is 39% vs 44%, respectively (Fig. 1).…”

Section: Definition and Prognosis Of Synchronous Lmmentioning

confidence: 99%

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Adam

Gramont

Figueras

et al. 2015

Cancer Treatment Reviews

488

413

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a b s t r a c tAn international panel of multidisciplinary experts convened to develop recommendations for managing patients with colorectal cancer (CRC) and synchronous liver metastases (CRCLM). A modified Delphi method was used. CRCLM is defined as liver metastases detected at or before diagnosis of the primary CRC. Early and late metachronous metastases are defined as those detected 612 months and >12 months after surgery, respectively. To provide information on potential curability, use of high-quality contrast-enhanced computed tomography (CT) before chemotherapy is recommended. Magnetic resonance imaging is increasingly being used preoperatively to aid detection of subcentimetric metastases, Contents lists available at ScienceDirectCancer Treatment Reviews j o u r n a l h o m e p a g e : w w w . e l s e v i e r h e a l t h . c o m / j o u r n a l s / c t r v and alongside CT in difficult situations. To evaluate operability, radiology should provide information on: nodule size and number, segmental localization and relationship with major vessels, response after neoadjuvant chemotherapy, non-tumoral liver condition and anticipated remnant liver volume. Pathological evaluation should assess response to preoperative chemotherapy for both the primary tumour and metastases, and provide information on the tumour, margin size and micrometastases. Although the treatment strategy depends on the clinical scenario, the consensus was for chemotherapy before surgery in most cases. When the primary CRC is asymptomatic, liver surgery may be performed first (reverse approach). When CRCLM are unresectable, the goal of preoperative chemotherapy is to downsize tumours to allow resection. Hepatic resection should not be denied to patients with stable disease after optimal chemotherapy, provided an adequate liver remnant with inflow and outflow preservation remains. All patients with synchronous CRCLM should be evaluated by a hepatobiliary multidisciplinary team.

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Section: Definition and Prognosis Of Synchronous Lmmentioning

confidence: 99%

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Adam

Gramont

Figueras

et al. 2015

Cancer Treatment Reviews

488

413

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“…One study looking at liver surgery for CLM in the elderly (>70 years old) reported a slightly higher mortality rate (3.8% versus 1.6%) and postoperative complication rate (15.9% versus 12.5%) compared with patients <70 years old. While patients need to be selected carefully in this group, they should not be excluded from potentially curative or life extending intervention solely on the basis of age [Adam et al 2010b]. The following criteria are generally considered to be contraindications to hepatic resection: Extensive unresectable extrahepatic disease (EHD), involvement of contralateral portal structures (e.g.…”

Section: Who Is Resectable?mentioning

confidence: 99%

What is the optimal neo-adjuvant treatment for liver metastasis?

Haraldsdóttir

Bloomston

et al. 2013

Ther Adv Med Oncol

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Colorectal cancer is the third most common cancer in the Western population and has a 5-year overall survival of 5-10% when metastatic. Approximately 30% of the patients with metastatic colorectal cancer have limited disease apparently isolated to the liver and, if this can be resected, the 5-year overall survival is improved to 30-60%. Therefore, it is important to identify patients who have both resectable disease and those with initially unresectable tumors who can potentially be downsized with chemotherapy to allow resection. First-line doublet chemotherapy regimens lead to response rates of 50-60%, triplet chemotherapy regimens may result in a response rate of up to 70%, and biological agents may add to responses or induce morphologic changes that facilitate disease resection. Surgical advances in recent years have also increased resectability rates and have challenged prior rules of resectability. Local therapies including ablation and radiation, often performed in conjunction with resection, may further aid in control of disease. The aim of this article is to focus on the role of neoadjuvant therapy in the treatment of colorectal liver metastases.

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“…Показано, в част-ности, что у больных с метастазами рака толстой кишки в печень успешная радикальная резекция позволяет до-биться высоких показателей отдаленной выживаемости вне зависимости от исходного возраста пациента [1]. В то же время, старение населения и расширение показаний к опе-рации делают оценку возможности проведения резекции печени у больных пожилого и старческого возраста, нередко страдающих серьезными сопутствующими заболеваниями, все более важной проблемой для хирургов-гепатологов [2].…”

Section: Introductionunclassified

Prevention of Non-Surgical Complications After Hepatic Resections in the Elderly Patients

Лядов¹,

Козырин²

2016

Zlokač. opuholi

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РезюмеПациенты пожилого и старческого возраста составляют все более значимую группу среди оперированных на печени больных. Высокий риск развития осложнений со стороны сердечно-сосудистой и дыхательной систем, а также послеоперационной энцефалопатии делает актуальным поиск методов профилактики подобных неспецифических осложнений резекций печени в данной группе пациентов. Нами изучено влияние стандартизированного протокола периоперационного ведения пациентов с заболеваниями печени в возрасте до и старше 70 лет на частоту данных осложнений. Материалы и методыПроанализированы результаты лечения пациентов, которым была выполнена резекция печени в отделении хирургической онкологии ФГАУ «ЛРЦ» за 2013-2016 гг. Проведен сравнительный анализ результатов 122 плановых резекций печени, проведенных у 99 больных в возрасте до 70 лет, и 30 аналогичных вмешательств, выполненных у 29 более пожилых пациентов. Среди пациентов старше 70 лет была отмечена значительно более высокая частота сопутствующих заболеваний сердечно-сосудистой системы, в то время как у более молодх пациентов значительно чаще проводилась предоперационная химиотерапия. Результаты Различий между группами по объему операций, продолжительности кровопотери, длительности вмешательств отмечено не было. Число тяжелых (III-IV ст. по классификации Dindo-Clavien) осложнений у пациентов до и старше 70 лет, соответственно, составило 22% и 20%, летальных исходов -6% и 7%. Несмотря на сопоставимую долю обширных резекций в группах пациентов, у более пожилых пациентов чаще развивалась печеночная недостаточность (13 против 7%). Неспецифические осложнения развились у 3 пациентов: пневмония и сердечная недостаточность в группе больных до 70 лет, и фибрилляция предсердий в группе пожилых пациентов. Заключение Применение стандартизированного протокола периоперационного ведения пациентов, нуждающихся в резекции печени, позволяет снизить число неспецифических осложнений операции вне зависимости от возраста. AbstractElderly patients constitute a significant part of patients undergoing liver resection. Non-specific cardio-vascular and pulmonary complications as well as postoperative delirium are common in this group of patients. We analyzed the impact of a standardized perioperative care protocol on the rate of such complications after resections of the liver in patients younger and older than 70 years. Material and methodsWe analyzed the results of elective liver resections, performed in the Department of Surgical Oncology of the Medical and Rehabilitation Center under the Ministry of Health from 2013 to 2016. There were 122 resection in 99 patients less than 70 years old and 30 procedures in 29 elderly patients. Patients in the elderly group had significantly more cardio-vascular co-morbidities whereas younger patients have had preoperative chemotherapy more often. Results There were no differences regading the extent of liver resection, bloodloss, operating time. Severe morbidity (Clavien-Dindo III-IV grade) developed in 22 and 20% among patients younger and older 70, respectively, m...

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Liver resection of colorectal metastases in elderly patients

Abstract: Liver resection for CLM in elderly patients can achieve a reasonable 3-year survival rate, with an acceptable morbidity rate. There should be no upper age limit but risk factors may help predict potential benefit.

Cited by 224 publications

References 26 publications

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

What is the optimal neo-adjuvant treatment for liver metastasis?

Prevention of Non-Surgical Complications After Hepatic Resections in the Elderly Patients

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