Hepatectomy for octogenarians with colorectal liver metastasis in the era of enhanced recovery

Andrea Tufo; Declan F J Dunne; Nichola Manu; Heman Joshi; Carmen Lacasia; Louise Jones; Hassan Z Malik; Graeme J Poston; Stephen W Fenwick

doi:10.1016/j.ejso.2018.01.089

Hepatectomy for octogenarians with colorectal liver metastasis in the era of enhanced recovery

Eur J Surg Oncol. 2018 Jul;44(7):1040-1047. doi: 10.1016/j.ejso.2018.01.089. Epub 2018 Feb 6.

Authors

Andrea Tufo¹, Declan F J Dunne², Nichola Manu², Heman Joshi², Carmen Lacasia², Louise Jones², Hassan Z Malik², Graeme J Poston², Stephen W Fenwick²

Affiliations

¹ Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK. Electronic address: andrea.tufo@nhs.net.
² Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK.

PMID: 29456045
DOI: 10.1016/j.ejso.2018.01.089

Abstract

Background: Concern exists regarding the use of hepatectomy to treat colorectal liver metastasis (CRLM) in octogenarians due to prior studies suggesting elevated morbidity and mortality. Cardiopulmonary exercise testing (CPET) within pre-operative assessment and enhanced recovery after surgery (ERAS) have both been shown to be associated with low morbidity and mortality in patients undergoing hepatectomy. This study sought to compare the outcomes of octogenarians with patients aged 70-79 undergoing hepatectomy for CRLM, within a center utilizing both CPET and ERAS.

Methods: Consecutive patients age 70 or older who underwent hepatectomy for CRLM at Aintree University Hospital (Liverpool,UK), between May 2008 and May 2015 were identified from a prospectively maintained cancer database. Data were extracted and comparisons drawn.

Results: 127 patients aged 70-79 years and 34 octogenarians underwent respectively 137 and 35 hepatectomy for CRLM. There was no difference in hospital stay (6 days), morbidity and mortality between the groups. OS at 1, 3 and 5 years were 86.7%, 55% and 35.8% for those aged 70-79 compared to 79.4%, 37.3% and 20.4% for the octogenarians (p=0.127). DFS at 1,3 and 5 years was 52.5%, 31.7% and 31.7% for 70-79 group compared to 46.2%, 31.5% and 16.8% for the octogenarians (p=0.838). On multivariate analysis major hepatectomy was associated with an increased risk of post-operative complications, inferior OS and DFS. Chronological age was not a predictor of postoperative complications, poorer OS or DFS.

Conclusions: Appropriately selected octogenarians can have similar postoperative outcomes to patients aged 70-79 when undergoing hepatectomy for CRLM using ERAS combined with CPET. This study advocates using CPET and ERAS in the selection and management of octogenarian patients with CRLM undergoing hepatectomy.

Keywords: Colorectal liver metastases; Liver surgery; Octogenarians; Surgery in the elderly.

MeSH terms

Age Factors
Aged
Aged, 80 and over
Clinical Protocols*
Colorectal Neoplasms / pathology*
Disease-Free Survival
Exercise Test
Female
Hepatectomy / methods*
Humans
Length of Stay
Liver Neoplasms / secondary
Liver Neoplasms / surgery*
Male
Metastasectomy / methods*
Multivariate Analysis
Patient Selection
Perioperative Care*
Postoperative Complications / epidemiology*
Preoperative Care
Retrospective Studies
Survival Rate
Treatment Outcome