Operative morbidity and survival following hepatectomy for colorectal liver metastasis in octogenarians: a contemporary case matched series.

Abstract

BACKGROUND:

Clinical outcomes of octogenarians undergoing hepatectomy for colorectal liver metastases (CRLM) are poorly characterized. The current study evaluated operative morbidity, mortality and survival outcomes among a contemporary cohort of octogenarians.

METHODS:

Patients undergoing their first hepatectomy for CRLM were identified from institutional databases and those ≥80 years old (y) were matched 1:1 to a group of patients <80 y. Data pertaining to surgical morbidity/mortality and survival were compared using standard statistical methods.

RESULTS:

From 2002 to 2012, 1391 hepatectomies were performed for CRLM, 55 (4%) in patients ≥80 y. Major complications occurred twice as frequently among patients ≥80 y [10 (19%) ≥80 y versus 5 (9%) <80 y, (p = 0.270)]. No matched patient <80 y. died within 90 d of operation, whereas, 4 (7%) patients ≥80 y did, p = 0.125. Median follow-up was significantly longer for the <80 y group [44 (1-146) versus. 23 (0-102) mths, p = 0.006]. Probability of disease recurrence was not different between groups (p = 0.123) nor was the cumulative incidence of death from disease (p = 0.371). However, patients ≥80 y had significantly higher incidence of non-cancer related death (p = 0.012).

CONCLUSIONS:

Hepatectomy for CRLM among well-selected octogenarians is reasonable with cancer related survival outcomes similar to those observed in younger patients. However, it is associated with clinically significant morbidity/mortality and continued efforts directed at optimizing perioperative care are necessary to improve early outcomes among octogenarians.

• Authors: Julie N Leal, Eran Sadot, Mithat Gonen, Stuart Lichtman, T Peter Kingham, Peter J Allen, Ronald P DeMatteo, William R Jarnagin, Michael I D'Angelica
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 19 Issue 2 Pg. 162-169 (02 2017) ISSN: 1477-2574 [Electronic] England
• PMID: 27914765 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Topics

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Colorectal Neoplasms (mortality, pathology)
• Databases, Factual
• Disease Progression
• Disease-Free Survival
• Female
• Hepatectomy (adverse effects, mortality)
• Humans
• Liver Neoplasms (mortality, secondary, surgery)
• Male
• Matched-Pair Analysis
• Metastasectomy (adverse effects, methods, mortality)
• Middle Aged
• Postoperative Complications (etiology)
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome