Liver does not care about age

O. Turrini1,*, J. Guiramand1, V. Moutardier1, F. Viret2, E. Bories3, M. Giovannini3, N. Pernoud4, J.-L. Blache4 and J.-R. Delpero1

Departments of 1 Surgical Oncology, 2 Medical Oncology, 3 Gastroenterology-Endoscopy and 4 Intensive Care, Institut Paoli-Calmettes, Marseille, France

* Email: oturrini{at}yahoo.fr

Because elderly patients have associated diseases, old age has been regarded as an adverse factor for liver resection (LR) [1Go]. Consequently, resectable hepatic metastasis from colorectal cancer (HMCC) in the elderly are still more frequently treated by chemotherapy. On the other hand, recent series showed that after major LR in aged people, liver function is preserved, with acceptable morbidity [2Go]. However, the impact on long-term survival is not clear, because aged patients often die of another pathology. Thus, data on 185 patients who had undergone a major LR (removing at least four Couinaud's segments) between January 1990 and December 2002 were retrieved from an ongoing database. Medical charts of patients initially operated on for colorectal cancer were studied by two hepatic surgeons, regardless of name and age. Only patients who fulfilled the further following criteria were selected for the present study: (i) metachronous hepatic metastasis, (ii) needing major LR for up to three metastasis, (iii) no underlying hepatic disease, (iv) no local recurrence of disease, (v) no extra-hepatic metastasis evaluated by repeat body scan, and (vi) no progressive hepatic disease after a treatment-free period of 2 months. Of these, 33 patients were aged at least 70 years old. Fifteen patients underwent direct major LR without postoperative chemotherapy. Eighteen patients received only the LVFU2 regimen combined with irinotecan (FOLFIRI protocol) because of either ASA score 3 (n=12) or patients refusal of surgery (n=6). For the two groups, global survival was calculated using the Kaplan–Meier method, and cause of death was examined.

No patient was lost to follow-up or died of a cause other than colorectal cancer disease during a median observation time of 49 months. Mortality and morbidity of group 1 were 0% and 33%, respectively. All patients in group 2 died during the observation time. Survival at 1, 2 and 5 years of all 33 patients were 91%, 61% and 23%, respectively. The median survival rate was 28 months. Survival at 1 and 2 years for groups 1 and 2 were 73% and 50% (P=0.04) and 47% and 15% (P <0.05), respectively. The median survival for groups 1 and 2 was 22 and 12 months, respectively (P=0.03).

Our series indicated that exclusive major LR for HMCC in elderly patient can be safe and can improve survival. Patient age is a useful prognostic factor for prediction of postoperative liver failure. Thus, surgeons use less aggressive procedures because of higher comorbidity rates [3Go]. As a result, we found that postoperative complications and operative mortality rates after major LR did not differ from those in younger patients [4Go]. Surgical resection of HMCC improved survival because the benefit of major LR was not offset by high postoperative mortality. In fact, patients >70 years old who were eligible for surgery but who are treated exclusively by chemotherapy had a reduced life expectancy. Surgical eligibility is classically determined by number and location of tumors, as for younger patients [5Go]. In our experience, selected elderly patients with HMCC benefited from resection as much as young patients, and age alone may not be a contraindication to surgery. Association with thermoablation by radiofrequency could raise the limits of management of multimetastatic liver in the elderly.


    References
 Top
 References
 
1. Nagasue N, Chang YC, Takemoto Y et al. Liver resection in the aged (seventy years or older) with hepatocellular carcinoma. Surgery 1993; 113: 148–154.[ISI][Medline]

2. Ettorre GM, Sommacale D, Farges O et al. Postoperative liver function after elective right hepatectomy in elderly patients. Br J Surg 2001; 88: 73–76.[CrossRef][Medline]

3. Koperna T, Kisser M, Schulz F. Hepatic resection in the elderly. World J Surg 1998; 22: 406–412.[CrossRef][ISI][Medline]

4. Bradley AL, Chapman WC, Wright JK et al. Surgical experience with hepatic colorectal metastasis. Am Surg 1999; 65: 560–566.[ISI][Medline]

5. Fong Y. Surgical therapy of hepatic colorectal metastasis. CA Cancer J Clin 1999; 49: 231–255.[Abstract/Free Full Text]





This Article
Full Text (PDF)
All Versions of this Article:
16/5/836    most recent
mdi142v1
E-letters: Submit a response
Alert me when this article is cited
Alert me when E-letters are posted
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in ISI Web of Science
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Disclaimer
Request Permissions
Google Scholar
Articles by Turrini, O.
Articles by Delpero, J.-R.
PubMed
PubMed Citation
Articles by Turrini, O.
Articles by Delpero, J.-R.