Advanced age; not a contraindiction for resections of colorectal liver metastasis recurrence

Aim: The influence of advanced age on the outcome of repeat resections performed for colorectal liver metastasis (CLM) is ill-defined. We aimed to evaluate the safety and efficacy of repeat resections performed for the recurrence of CLMs in younger (≤70 years) and elderly patients (70< years), and to define predictive factors of survival. Material and Method: A prospectively maintained database of a single center including 291 CLM patients between 1998 and 2019 was analyzed retrospectively. Short and long-term outcomes were compared among younger (n=99, 34%) and elderly (n=192, 66%) patient groups who were treated by repeat resections for CLM recurrence. Results: Although statistically not significant, analysis of different age groups (≤70, 70-75, 75-80, and 80< years) have given similar results in terms of 1, 3, and 5-year survival (p=0.143). Globally curative resection was validated as a determinant factor in the estimation of survival following resections performed for recurrences according to multivariate analysis (p<0.05). Conclusion: Repeat resections for the recurrence of CLMs in selected elderly patients are reliable with regards to similar survival outcomes achieved compared to their younger counterparts.

Keywords:

Colorectal liver metastasis (CLM), liver recurrence, resection elderly patients,

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Chong G, Cunningham D. Improving long-term outcomes for patients with liver metastases from colorectal cancer. J Clin Oncol 2005; 23: 9063–6.
Stangl R, Altendorf-Hofmann A, Charnley RM. Factors influencing the natural history of colorectal liver metastases. Lancet 1994; 343: 1405–10.
Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 2006; 94: 982-99.
Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239: 818-27.
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230: 309-21.
Zorzi D, Mullen JT, Abdalla EK, et al. Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg 2006; 10: 86-94.
Sa Cunha A, Laurent C, Rault A, Couderc P, Rullier E, Saric J. A second liver resection due to recurrent colorectal liver metastases. Arch Surg 2007; 142: 1144-50.
Nishio H, Hamady ZZ, Malik HZ, et al. Outcome following repeat liver resection for colorectal liver metastases. Eur J Surg Oncol 2007; 33: 729–34.
de Jong MC, Pulitano C, Ribero D, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg 2009; 250: 440–8.
Brachet D, Lermite E, Rouquette A, Lorimier G, Hamy A, Arnaud JP. Prognostic factors of survival in repeat liver resection for recurrent colorectal metastases: review of sixty-two cases treated at a single institution. Dis Colon Rectum 2009; 52: 475–83.
Brand MI, Saclarides TJ, Dobson HD, Millikan KW. Liver resection for colorectal cancer: liver metastases in the aged. Am Surg 2000; 66: 412-6
Rubbia-Brandt L, Giostra E, Brezault C, et al. Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol 2007; 18: 299-304.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205–13.
Fernández-Trigo V, Shamsa F, Sugarbaker PH. Repeat liver resections from colorectal metastasis. Repeat Hepatic Metastases Registry. Surgery 1995; 117: 296-304.
Ziff O, Rajput I, Adair R, Toogood GJ, Prasad KR, Lodge JP. Repeat liver resection after a hepatic or extended hepatic trisectionectomy for colorectal liver metastasis. HPB (Oxford) 2014; 16: 212-9.
Rubbia-Brandt L, Audard V, Sartoretti P, et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 2004; 15: 460-6.
Pilgrim CH, Satgunaseelan L, Pham A, et al. Correlations between histopathological diagnosis of chemotherapy-induced hepatic injury, clinical features, and perioperative morbidity. HPB (Oxford) 2012; 14: 333-40.
Pawlik TM, Olino K, Gleisner AL, Torbenson M, Schulick R, Choti MA. Preoperative chemotherapy for colorectal liver metastases: impact on hepatic histology and postoperative outcome. J Gastrointest Surg 2007; 11: 860–8.
Karoui M, Penna C, Amin-Hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006; 243: 1-7.
Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 2006; 24: 2065-72.
You SH, Park BJ, Kim YH. Hepatic Lesions that Mimic Metastasis on Radiological Imaging during Chemotherapy for Gastrointestinal Malignancy: Recent Updates. Korean J Radiol 2017; 18: 413-26.
Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239: 818-27.
Viganò L, Capussotti L, Majno P, et al. Liver resection in patients with eight or more colorectal liver metastases. Br J Surg 2015; 102: 92-101.
Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 2006; 94: 982-99.
Petrowsky H, Gonen M, Jarnagin W, et al. Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis. Ann Surg 2002; 235: 863-71.
Omichi K, Shindoh J, Cloyd JM, et al. Liver resection is justified for patients with bilateral multiple colorectal liver metastases: A propensity-score-matched analysis. Eur J Surg Oncol 2018; 44: 122-9.
Fukami Y, Kaneoka Y, Maeda A, et al. Bilobar versus unilobar multiple colorectal liver metastases: a propensity score analysis of surgical outcomes and recurrence patterns. J Hepatobiliary Pancreat Sci 2017; 24: 153-60.
Petrowsky H, Linecker M, Raptis DA, et al. First long-term oncologic results of the ALPPS procedure in a large cohort of patients with colorectal liver metastases. Ann Surg 2020; 272: 793-800.
Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004; 240: 644-58.
Wicherts DA, de Haas RJ, Salloum C, et al. Repeat hepatectomy for recurrent colorectal metastases. Br J Surg 2013; 100: 808-18.
Viganò L, Torzilli G, Troisi R, et al. CLISCO group. Minor hepatectomies: focusing a blurred picture: analysis of the outcome of 4471 open resections in patients without cirrhosis. Ann Surg 2019; 270: 842-51.
Mise Y, Aloia TA, Brudvik KW, Schwarz L, Vauthey JN, Conrad C. Parenchymal-sparing hepatectomy in colorectal liver metastasis improves salvageability and survival. Ann Surg 2016; 263: 146-52.