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Meta-Analysis
. 2020 Apr 22;15(4):e0230914.
doi: 10.1371/journal.pone.0230914. eCollection 2020.

Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis

Nicola de'Angelis  1 , Capucine Baldini  2 , Raffaele Brustia  3 , Patrick Pessaux  4 , Daniele Sommacale  5 , Alexis Laurent  1 , Bertrand Le Roy  6 , Vania Tacher  7 , Hicham Kobeiter  7 , Alain Luciani  7 , Elena Paillaud  8 , Thomas Aparicio  9 , Florence Canuï-Poitrine  10 , Evelyne Liuu  11
Affiliations
Meta-Analysis

Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis

Nicola de'Angelis et al. PLoS One. .

Erratum in

Abstract

Objective: The present study explored the existing literature to describe the outcomes of surgical and regional treatments for colorectal cancer metastases (mCRC) in older patients.

Methods: A literature search was conducted in PubMed, EMBASE, Cochrane and ClinicalTrials.gov for studies published since 2000 that investigated the short- and long-term outcomes of regional treatments (surgical or non-surgical) for mCRC in patients aged ≥65 years. Pooled data analyses were conducted by calculating the risk ratio (RR), mean differences (MD) and hazard ratio (HR) between older and younger patients or between two different approaches in older patients.

Results: After screening 266 articles, 29 were included in this review. These studies reported the outcomes of surgery (n = 19) and non-surgical local ablation treatments (n = 3) for CRC metastases in older vs. younger patients or compared the outcomes of different interventions in older patients (n = 7). When comparing older vs. younger patients undergoing liver surgery for mCRC, pooled data analysis showed higher postoperative mortality [RR = 2.53 (95%CI: 2.00-3.21)] and shorter overall survival [HR = 1.17 (95%CI: 1.07-1.18)] in older patients, whereas no differences in operative outcomes, postoperative complications and disease-free survival were found. When comparing laparoscopy vs. open surgery for liver resection in older mCRC patients, laparoscopy was associated with fewer postoperative complications [RR = 0.27 (95%CI: 0.10-0.73)].

Conclusion: Liver resection for mCRC should not be disregarded a priori in older patients, who show similar operative and postoperative outcomes as younger patients. However, clinicians should consider that they are at increased risk of postoperative mortality and have a worse overall survival, which may reflect comorbidities and frailty.

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Conflict of interest statement

Pr P Pessaux is an orator for Integra and a co-founder of VirtualiSurg. This affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors have nothing to disclose, and all authors have declared that no competing interests exist in relation to the matter of this study.

Figures

Fig 1
Fig 1. Flowchart of literature search and study selection process.
Fig 2
Fig 2. Forest plots of operative outcomes of liver resection for CRLM in older vs. younger patients.
The following outcomes were analyzed: a. operative time (min); b. transfusion rate (n); and c. R0 resection (n).
Fig 3
Fig 3. Forest plots of postoperative outcomes of liver resection for CRLM in older vs. younger patients.
The following outcomes were analyzed: a. overall postoperative complications (n), b. hospital stay (days), and c. mortality (n).
Fig 4
Fig 4. Forest plots of survival rates of older vs. younger patients after liver resection for CRLM.
The following outcomes were analyzed: a. overall survival and b. disease-free survival.
Fig 5
Fig 5. Forest plots of operative and postoperative outcomes of laparoscopic liver resection vs. open liver resection for CRLM in older patients.
The following outcomes were analyzed: a. blood loss (mL); b. operative time (min); c. major postoperative complications (n); d. hospital stay (days); e. overall survival; and f. disease-free survival.
See this image and copyright information in PMC

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