Seema Kumari1, Christine Semira2, Margaret Lee2,3,4,5,6, Belinda Lee2,5, Rachel Wong2,4,6, Louise Nott7, Jeremy Shapiro8, Peter Gibbs2,3,5. 1. Medical Oncology, Westmead Hospital, Sydney, New South Wales, Australia. 2. Medical Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia. 3. Medical Oncology, Western Health, Sydney, New South Wales, Australia. 4. Medical Oncology, Eastern Health, Melbourne, Victoria, Australia. 5. Medical Oncology, The University of Melbourne, Melbourne, Victoria, Australia. 6. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia. 7. Medical Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia. 8. Medical Oncology, Cabrini Health, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Colorectal cancer remains a common cancer in the western world, with liver resection being the only potentially curative option for isolated colorectal cancer liver metastases (CRCLM). Cancer is a disease of aging, with the optimum management of elderly patients with CRCLM presenting an ongoing dilemma. METHODS: We analysed the outcome of CRCLM using prospectively collected patient data from the multidisciplinary Treatment of Recurrent and Advanced Colorectal Cancer registry, collected from July 2009 to July 2018 at 12 Australian hospitals. RESULTS: Of 2742 patients with metastatic colorectal cancer, liver-limited disease was present in 977 (36%) patients, of whom 338 (35%) underwent hepatic resection. Resection rates varied with age, including 186 (43%) of 428 patients aged 64 years and younger, 99 (40%) of 245 aged 65-75 years and 53 (17%) of 303 aged 76 and older (P < 0.001). The 30-day mortality rate was 0.9%. Median survival post resection also varied with age, 96 versus 89 versus 68 months (P < 0.001). In a separate analysis of the oldest patients, those aged over 80 years, where only 11% underwent resection, the median survival was 49 months. CONCLUSION: The operative mortality for patients undergoing liver resection at Australian hospitals is low. With advancing age, the rate of liver resection of CRCLM and the post-resection survival decline. However, excellent survival outcomes can be achieved in selected elderly patients.
BACKGROUND:Colorectal cancer remains a common cancer in the western world, with liver resection being the only potentially curative option for isolated colorectal cancer liver metastases (CRCLM). Cancer is a disease of aging, with the optimum management of elderly patients with CRCLM presenting an ongoing dilemma. METHODS: We analysed the outcome of CRCLM using prospectively collected patient data from the multidisciplinary Treatment of Recurrent and Advanced Colorectal Cancer registry, collected from July 2009 to July 2018 at 12 Australian hospitals. RESULTS: Of 2742 patients with metastatic colorectal cancer, liver-limited disease was present in 977 (36%) patients, of whom 338 (35%) underwent hepatic resection. Resection rates varied with age, including 186 (43%) of 428 patients aged 64 years and younger, 99 (40%) of 245 aged 65-75 years and 53 (17%) of 303 aged 76 and older (P < 0.001). The 30-day mortality rate was 0.9%. Median survival post resection also varied with age, 96 versus 89 versus 68 months (P < 0.001). In a separate analysis of the oldest patients, those aged over 80 years, where only 11% underwent resection, the median survival was 49 months. CONCLUSION: The operative mortality for patients undergoing liver resection at Australian hospitals is low. With advancing age, the rate of liver resection of CRCLM and the post-resection survival decline. However, excellent survival outcomes can be achieved in selected elderly patients.