Global graying, colorectal cancer and liver metastasis: new implications for surgical management

Aging of the population - global graying - is occurring rapidly, with significant effects on epidemiology, treatment and outcomes for cancer patients. In colorectal cancer, outcomes for the elderly are worse than those for younger patients, partially driven by treatment disparities between the two groups. Nonetheless, standard-of-care treatment for the elderly results in equivalent long-term outcomes to those observed in the younger population; and available data support the use of aggressive surgery and adjuvant therapies in well-selected patients. Data evaluating epidemiology, treatment patterns and outcomes in elderly patients with colorectal cancer liver metastasis are lacking. Liver resection offers the only curative approach, but it is rarely offered to older adults. Current data support the use of hepatectomy for well-selected elderly colorectal cancer patients with liver metastasis; however, this and other evolving therapies need to be assessed in the elderly to better define their role, indications, safety and outcomes.