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Older patients undergoing liver resection face greater postoperative mortality risk
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Older patients undergoing resection for colorectal cancer liver metastases faced increased risk for postoperative mortality despite receiving less aggressive treatment, according to the results of a retrospective cohort study.
However, a large proportion of older patients who undergo the surgical procedure will achieve long-term survival, the researchers also reported.
Surgical resection has become a standard treatment for colorectal cancer liver metastases, with clinical trial data suggesting a considerable long-term survival benefit, according to study background. However, limited data exist regarding the procedural practice and outcomes in older patients.
Thus, Christopher M. Booth, MD, FRCPC, associate professor of oncology at Queen’s University Cancer Research Institute in Kingston, Ontario, and colleagues conducted a population-based retrospective cohort study to describe management and outcomes of surgical resection in this patient group.
Using the Ontario Cancer Registry, Booth and colleagues identified all patients who underwent liver resection between January 2002 and December 2009. Researchers had access to vital status through December 2012, as well as cause of death information through December 2010.
The use of perioperative chemotherapy — defined as chemotherapy given within 16 weeks of therapy — was identified through linked electronic treatment and physician billing records.
OS and disease-specific survival (DSS) measured from time of resection served as the primary endpoints.
The study included data from 1,310 patients (median age, 63 years; range 20-87). The researchers divided patients into three age groups: younger than 65 years (n = 710), 65 years to 74 years (n = 414), and 75 years or older (n = 186).
The researchers identified a case volume of one resection per 26 cases in patients aged younger than 65 years; one resection per 38 cases in patients 65 years to 74 years; and one resection per 101 cases in patients aged 75 years or older (P < .001).
The mean number of lesions differed by age group (< 65 years, 2.3; 65-74 years, 2; ≥ 75 years, 1.6; P < .001). The mean size of the largest lesion also differed by age (< 65 years, 4 cm; 65-74 years, 4.4 cm; ≥ 75 years, 4.5; P = .04).
Patients aged younger than 65 years and patients aged 65 years to 74 years appeared more likely to undergo a major liver resection of more than three segments than patients aged 75 years or older (65% vs. 42%; P = .04).
Perioperative chemotherapy occurred in 71% (n = 501) of patients aged younger than 65 years, 57% (n = 237) of patients aged 65 years to 74 years, and 41% (n = 77) of patients aged 75 years or older (P < .001).
Two percent of patients aged younger than 65 years died within 90 days of surgery, compared with 5% of patients aged 65 years to 74 years and 8% of patients aged 75 years or older (P < .001).
The DSS rate at 5 years was 49% for patients aged younger than 65 years, 47% for patients aged 65 years to 74 years, and 35% for patients aged 75 years or older (P < .001).
The OS rate for patients aged younger than 65 years was 49%, compared with 44% for patients aged 65 years to 74 years and 28% for patients aged 75 years or older (P < .001).
The researchers acknowledged limitations of their study, including the potential for bias through misclassification inherent in the use of a population database. Further, they were only able to partially control for potential comorbidity.
“Further work is needed to better understand the optimal treatment of older patients with colorectal cancer liver metastases,” Booth and colleagues wrote. – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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