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Age-Associated Morbidity After Major Hepatectomy for Colorectal Liver Metastases
Bryant Morocho1, Catherin Morocho1, David Bertsch1
1Department of General Surgery, Department of Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA.
Introduction:
As our population ages, older patients are increasingly presenting for surgical management of advanced malignancies. Hepatectomy for colorectal liver metastasis (CRLM) prolongs survival. The goal of this study was to understand postoperative morbidity and the rate of failure to rescue in older patients undergoing major hepatic resection for CRLM.
Methods:
We reviewed the American College of Surgeons (ACS) National Surgical Quality Improvement (NSQIP) targeted data set for hepatectomy from 2014 to 2024 to identify patients who underwent major hepatectomy for CRLM. Univariate and multivariable logistic regression analyses were performed to evaluate the risk factors associated with failure to rescue.
Results:
A total of 4119 patients undergoing hepatectomy for CRLM were included. Age group distribution was as follows: < 70 years (n = 3346), 70-79 years (n = 663), and ≥ 80 years (n = 110). Older patients were more likely to experience cardiac complications (p < 0.001), post-hepatectomy liver failure (PHLF) (p < 0.001), and failure to rescue (p < 0.001). No significant differences in postoperative outcomes were observed between sexes. Multivariable logistic regression analysis showed that septuagenarians had higher odds of failure to rescue than patients aged < 70 years (2.36, 95% CI: 1.29-4.33). PHLF (OR 2.98, 95% CI: 1.69-5.25) and cardiac complications (OR 21.75, 95% CI: 11.69-40.47) were associated with higher odds of failure to rescue.
Conclusion:
Older age was significantly associated with postoperative morbidity and failure to rescue in patients undergoing major hepatectomy for CRLM. We identified cardiac complications and PHLF as potential causes associated with failure to rescue.
