The Surgical Management of Colorectal Cancer Liver Metastases in the Elderly: A Retrospective Study in the UK

Introduction: The number of elderly patients with colorectal cancer (CRC) liver metastases is increasing. Due to their historic exclusion from clinical trials, evidence for the benefit of hepatic resection in this population is limited. The present study aimed to assess the safety and efficacy of hepatic resection for CRC liver metastases in elderly patients.
Methods: A 5-year retrospective analysis of all patients who underwent hepatic resection for CRC liver metastases at a single UK centre was performed to compare outcomes for young (<75 years old), and elderly (>75 years old) patients.
Results: Of 248 patients identified, 44 were elderly and 204 were young. The majority of patients were male (71%), underwent a minor resection (64%) and had a complete resection (87%). There was no significant difference in demographic or surgical characteristics other than age. The 5- year disease-free survival (DFS) and overall survival (OS) for all groups combined was 28.8% and 37.9%, respectively. Between the elderly and young groups there was no significant difference in median DFS (27 months vs. 32 months) but a significant difference in OS (29 months vs. 46 months). Tumour recurrence was identified to significantly predict OS for both elderly and young patients, whilst gender, type of resection, and residual tumour classification status had no statistically significant predictive value.
Conclusion: The results of the current study indicate that hepatic resection for CRC liver metastases is a safe and effective procedure in all age groups, with non-inferior outcomes in patients >75 years old.