REFILE-Benefits of laparoscopic liver surgery for colorectal mets may decrease with age

Last Updated: 2017-03-03

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By Will Boggs MD

NEW YORK (Reuters Health) - Laparoscopic liver resection for colorectal metastases appears to offer significant benefits over open liver resection in elderly patients, but these benefits may diminish with increasing age.

"It is surprising that those between 70-74 years old benefit much more than those >80 years old, but this could be due to small numbers,�€ Dr. Mohammad Abu Hilal from University Hospital Southampton NHS Foundation Trust, in the UK, told Reuters Health.

Numerous studies have shown laparoscopic liver resection to be a safe, feasible, and oncologically efficient alternative to open liver resection for colorectal liver metastases, but most studies that included elderly patients treated them as a homogeneous group.

Dr. Abu Hilal's team used data from five tertiary liver centers to compare the short- and long-term outcomes of laparoscopic (LLR) and open liver resection (OLR) among 775 elderly patients (70+ years old) with colorectal liver metastases, including a propensity-score-matched analysis of 225 pairs of patients.

Blood loss, median total and high dependency hospital stay, minor and major morbidity, and the incidence of lower respiratory tract infection were all significantly lower in the LLR group than in the OLR group, they report in Annals of Surgery, online February 1.

During long-term follow-up, median recurrence-free survival was 33 months with LLR versus 27 months with OLR (p=0.502), and median overall survival was 51 months with LLR and 45 months with OLR (p=0.671).

In subgroup analysis, all the benefits of LLR over OLR persisted in patients between 70 and 74 years. Most advantages persisted among 75- to 79-year-olds, but the differences in major morbidity and total hospital stay lost statistical significance.

When only those aged 80 and above were considered, there were trends towards better short-term outcomes, but only the shorter duration of high dependency stay remained statistically significant.

�€œI would try to offer minimally invasive surgery to all my patients when possible technically,�€ Dr. Abu Hilal concluded. �€œIf we can reduce the trauma related to the access we need to be able to perform the operation, we will be able to improve patients�€™ tolerance to the operative stress and improve outcomes.�€

SOURCE: http://bit.ly/2mSkqe3

Ann Surg 2017.