Takeaway
- Using pre-operative cardiopulmonary exercise testing (CPET) and enhanced recovery after surgery (ERAS), octogenarians undergoing hepatectomy for colorectal liver metastasis (CRLM) have similar postoperative outcomes and overall survival as patients aged 70-79 yrs.
Why this matters
- 70% of colorectal cancer diagnoses occur after age 65, and 50% occur in patients >70 yrs.
- Previous studies have suggested increased morbidity and mortality among octogenarians undergoing hepatectomy for CRLM.
- This study advocates the use of CPET and ERAS to select and manage octogenarians with CRLM who undergo hepatectomy.
Key results
- 137 hepatectomies were performed on 127 patients aged 70-79 yrs.
- 35 hepatectomies were performed on 34 octogenarians.
- Median length of hospital stay was 6 days in both groups (P=.689).
- High Dependency Unit /Intensive Therapy Unit (HDU/ITU) stay was required after 62.2% of procedures in the 70-79 yr group and 77.1% of octogenarians.
- Median length of HDU/ITU stay was 1 day in both groups (P=.075).
- Rate of post-operative complications was 25.5% in 70-79 yr olds and 40% in octogenarians (P=.098).
- Post-operative mortality was 1.5% and 2.8%, respectively (P=.495).
- 1-yr overall survival (OS) was 86.7% for those aged 70-79 vs 79.4% for octogenarians.
- 5-yr OS rates were 35.8% vs 20.4%, respectively.
- 1-yr disease-free survival (DFS) rates were 52.5% for 70-79yrs group vs 46.2% for the octogenarians.
- 5-yr DFS was 31.7% vs 16.8%.
- Age was not associated with either poorer survival (P=.127) or poorer DFS (P=.838).
Study design
- Retrospective study of prospectively maintained data related to consecutive patients aged ≥70yrs who underwent hepatectomy for CRLM at Aintree University Hospital in Liverpool between May 2008 and May 2015.
- Funding: self-funded.
Limitations
- The groups had differences in disease presentation and burden.
- Treatments prior to and following liver resection were not standardised and/or matched.
References
References
