First and repeat resection of colorectal liver metastases in elderly patients

Abstract

Objective: The objective of this study was to evaluate the short- and long-term outcome after first and repeat resection in patients older than 70 years.

Summary background data: Liver resection is the best treatment for colorectal liver metastases and is currently increasingly performed in elderly patients. The benefit of resection for these patients needs to be evaluated.

Methods: Between 1990 and 2000, 56 first and 16 repeat liver resections were performed in 61 patients older than 70 years. Patients were identified from a prospective database and records were reviewed retrospectively.

Results: First and repeat liver resection resulted, respectively, in a 0% and 7% postoperative mortality rate and a 41% and 38% complication rate, respectively. Median survival after first resection of 53 patients with R0 resection was 33 months, and the 5-year survival rate was 22%. Factors associated with poor long-term survival in multivariate analysis were extrahepatic disease, high carcinoembryonic antigen level over 200 ng/mL, and the presence of 3 or more liver metastases. Patients without these risk factors showed a median survival of 42 months and a 5-year survival rate of 36%. Repeat liver resection resulted in a median survival of 17 months and in a 3-year survival rate of 25%.

Conclusion: First and repeat liver resection for colorectal liver metastases can be performed safely in patients older than 70 years. A 5-year survival rate similar to those of younger patients can be expected after first liver resection for patients without the presence of risk factors.

FIGURE 1. Overall survival for 53 elderly patients after R0 first liver resection according to the presence or absence of risk factors (carcinoembryonic antigen level over 200 ng/mL, 3 or more liver metastases, presence of extrahepatic disease) in each patient.