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Long-term outcome after liver surgery for colorectal metastases in elderly patients: a nationwide population-based
Victor van Woerden1, Michelle R de Graaff2, Arthur K E Elfrink3
1Department of Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands.
Background:
Age alone is no longer a contraindication for resection of colorectal liver metastases (CRLM). The aim of this study was to compare survival after resection of CRLM across different age groups.
Methods:
A population-based study of patients who underwent resection of CRLM in the Netherlands between 2014 and 2022 was performed. For survival analyses, data from 2014 to 2018 were used. Patients were divided into three groups: <70, 70-80, and ≥80 years. Main outcomes were overall survival (OS) and relative survival (RS), defined as survival relative to age-matched survival in the general population. Secondary outcomes included short-term postoperative outcome and risk factors influencing survival.
Results:
Among 6415 patients, 3874 (60.3 %) were <70 years, 2042 (31.8 %) were 70-80, and 499 (7.7 %) were ≥80 years. Median OS was 54.2 months (<70), 47.1 months (70-80), and 40.7 months (≥80). Five-year RS was 51.8 %, 57.9 %, and 64.0 %, respectively. In multivariable analysis, age 70-80 (aHR 1.20) and ≥80 (aHR 1.50) were associated with worse OS. Other independent risk factors included Charlson score ≥2, ASA ≥3, >3 CRLM, largest CRLM >4 cm, synchronous or extrahepatic disease, and major complications.
Conclusion:
Resection of CRLM in selected elderly patients results in acceptable overall survival.
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