Surgery for Liver Metastases
Life expectancy has increased significantly in recent years. Along with this even the definition of an elderly patient has been modified over the years. During the last two decades the cut-off point of 70 years became the most commonly used in literature, replacing the 65 years cut-off wider adopted in the past.
Colorectal cancer is one the most common malignant tumors in the Western world and remains the second most common cause of cancer related deaths in the United States. Up to 76% of all people affected by colorectal cancer are diagnosed between the ages of 65 and 85; and 33–50% of patients with colorectal liver metastases are 70 years old and beyond.
Over the last twenty years the number of elderly patients considered for live resection has been increasing constantly.
Nowadays, techniques in the field of hepatic surgery and peri-operative care has improved dramatically achieving mortality rates that vary between 0% and 11%, even for procedures combining colon resection with liver resection.
Recent studies published in literature showed no significant difference in postoperative complications and postoperative mortality between the age specific subgroups of patients undergoing liver resections for colorectal liver metastases. Long term survival is comparable to younger patients and a multimodality approach to metastatic disease using peri-operative chemotherapy is now established in the elderly and its use can be associated with improved results. When non resectable and only localized to the liver, colorectal liver metastases can be treated by ablative techniques such as Radiofrequency Ablation and Microwave Ablation. Such procedures, with or without the aid chemotherapy, can provide a significant improvement in overall survival.
Increasing age itself it is not a predictor of short survival therefore elderly patient affected by colorectal liver metastases should be always considered for liver resection when feasible.
KeywordsLiver metastases Colorectal metastases Liver surgery Colorectal Elderly
- 1.World Health Organisation. World Health Statistics 2009. WHO Library Cataloguing-in-Publication Data. pp. 35.Google Scholar
- 18.Falcone A, Ricci S, Brunetti I, Pfanner E, Allegrini G, Barbara C, Crino L, Benedetti G, Evangelista W, Fanchini L, Cortesi E, Picone V, Vitello S, Chiara S, Granetto C, Porcile G, Fioretto L, Orlandini C, Andreuccetti M, Masi G. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol. 2007;25(13):1670–6.PubMedCrossRefGoogle Scholar
- 28.Di Benedetto F, Berretta M, D’Amico G, Montalti R, De Ruvo N, Cautero N, Guerrini GP, Ballarin R, Spaggiari M, Tarantino G, Di Sandro S, Pecchi A, Luppi G, Gerunda GE. Liver resection for colorectal metastases in older adults: a paired matched analysis. J Am Geriatr Soc. 2011;59:2282–90.PubMedCrossRefGoogle Scholar
- 30.Barone C, Nuzzo G, Cassano A, Basso M, Schinzari G, Giuliante F, D’Argento E, Trigila N, Astone A, Pozzo C. Final analysis of colorectal cancer patients treated with irinotecan and 5-fluorouracil plus folinic acid neo-adjuvant chemotherapy for unresectable liver metastases. Br J Cancer. 2007;97(8):1035.PubMedCrossRefGoogle Scholar
- 32.Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M, Parodi S, Dal Lago D, Gioia F, Monfardini S, Aapro MS, Serraino D, Zagonel V. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol. 2002;20(2):494–502.PubMedCrossRefGoogle Scholar
- 34.Pope D, Ramesh H, Gennari R, Corsini G, Maffezzini M, Hoekstra HJ, Mobarak D, Sunouchi K, Stotter A, West C, Audisio RA. Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol. 2006;15(4):189–97.PubMedCrossRefGoogle Scholar
- 48.Martin RC, Robbins K, Tomalty D, O’Hara R, Bosnjakovic P, Padr R, Rocek M, Slauf F, Scupchenko A, Tatum C. Transarterial chemoembolisation (TACE) using irinotecan-loaded beads for the treatment of unresectable metastases to the liver in patients with colorectal cancer: an interim report. World J Surg Oncol. 2009;7:80.PubMedCrossRefGoogle Scholar