ORLANDO — Liver resection of colorectal metastases was associated with good long-term survival among patients over age 70 years in an analysis based on 20 years of data from an international registry.
Five-year survival after surgery was 37% in a cohort of 729 patients aged 70 years and older and 44% in patients younger than 70 years old. The variations in survival, however, appeared to be associated primarily with the type of disease present rather than solely attributable to patient age, according to lead author Dr. René Adam of Hôpital Paul Brousse, Villejuif, France. Further, 5-year survivals after resection were not different between patients aged 70–75 years, 76–80 years, and 81 years or older.
Perioperative mortality was 4% in the senior group and 2% in the younger group, but selecting candidates for resection based on predictive risk factors would balance some of the risks of surgery, according to Dr. Adam, who presented the data as a poster at a meeting on gastrointestinal cancers sponsored by the American Society of Clinical Oncology.
Further, given the slightly higher rate of curative hepatectomy seen in the elderly group, “doing liver resection in these patients is definitely worthwhile,” he said.
He and his colleagues analyzed the LiverMetSurvey registry of patients undergoing surgery for colorectal liver metastases from January 1986 to July 2006. The registry prospectively collected data on 3,662 patients who had resections at 36 centers in 11 countries. Of the 729 patients who were 70 years or older, 463 were 70–75 years; 194 were 75–80 years, and 72 were 80 years or more.
The total cohort of elderly patients was compared with the younger population. A multivariate analysis also was performed to determine which factors were predictive of survival after resection.
Multinodular disease (at least 3 hepatic nodules) was present in 675 (23%) of the younger patients and 80 (11%) of the older patients. Elderly patients had a slightly higher rate of curative hepatectomy, 94% vs. 91% for younger patients. Further, recurrent disease was less common in the elderly patients; 34% of elderly patients and 43% of the younger group had recurrent disease after a mean follow-up of 32 months.