Clinical

Hepatic resection for colorectal metastases not contraindicated in elderly

Last Updated: 2004-12-01 11:17:41 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Liver resections to treat colorectal liver metastases can be performed with very low mortality and an "acceptable" morbidity in patients older than 70 years, French physicians report in the Annals of Surgery for November. Outcomes appear to be similar to those obtained with younger patients.

Liver resection is the only treatment that can offer long-term survival for these patients, explain Dr. Daniel Jaeck and colleagues at Hopital de Hautepierre in Strasbourg. Although as many as half of all patients with liver metastases are older than 70 years, most studies look primarily at results in younger patients.

Dr. Jaeck's group reviewed medical data of 56 first and 16 repeat liver resections performed in 61 consecutive patients older than 70 years between January 1990 and December 2000 at their institution.

There were no deaths after the first procedure. Among the 16 patients undergoing a second surgery, one death occurred during the immediate postoperative period. The death in this female patient, who had a history of hypokinetic cardiomyopathy, was caused by congestive heart failure.

Morbidity rates were 41% for first resections and 38% for repeat resections.

Three- and 5-year survival for 56 patients with first liver resection was 44% and 21%, respectively. Median survival was 28 months.

Multivariate analysis identified three factors associated with poor outcome: carcinoembryonic antigen (CEA) levels > 200 ng/mL, the presence of three or more liver metastases, and extrahepatic disease. In the 21 patients without these risk factors, 3- and 5-year survival was 59% and 36%, respectively. Median overall survival was 33 months.

In comparison, untreated patients have a median survival of 4.5 to 6.5 months, the authors note. Treatment with chemotherapy alone is associated with a median survival of 9.2 to 16.5 months.

"Therefore," Dr. Jaeck's group maintains, "first liver resection in the elderly is justified when a chance for a curative resection can be offered, [regardless] of the presence of poor prognostic factors."

For those undergoing a repeat operation, 3-year survival rate was 25%; there were no survivors at 5 years. Median survival was 17 months.

"Indications for repeat resection should be considered very selectively, and percutaneous local destruction by radiofrequency could be a good alternative to surgery for this group of patients," Dr. Jaeck and his associates conclude.

Ann Surg 2004;240:858-865.