The impact of advancing age on incidence of hepatectomy and post-operative outcomes in patients with colorectal cancer liver metastases: a population-based cohort study.

Autor:	Vallance AE; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, WC2A 3PE, UK. Electronic address: avallance@rcseng.ac.uk., Young AL; Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK., Kuryba A; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, WC2A 3PE, UK., Braun M; Medical Oncology, The Christie NHS Foundation Trust, Manchester, M20 4BX, UK., Hill J; Department of Colorectal Surgery, Manchester Royal Infirmary, Manchester, M13 9WL, UK., Jayne DG; Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK., van der Meulen J; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK., Lodge JP; Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK., Walker K; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2019 Feb; Vol. 21 (2), pp. 167-174. Date of Electronic Publication: 2018 Jul 31.
DOI:	10.1016/j.hpb.2018.06.1808
Abstrakt:	Background: Clinical outcomes for elderly patients undergoing liver resection for colorectal cancer (CRC) liver metastases are poorly characterised. This study aimed to investigate the impact of advancing age on the incidence of liver resection and post-operative outcomes. Methods: Patients in the National Bowel Cancer Audit undergoing major CRC resection from 2010 to 2016 in England were included. Liver resection was identified from linked Hospital Episode Statistics data. A Cox-proportional hazards model was used to compare 3-year mortality. Results: Of 117,005 patients, 6081 underwent liver resection. For patients <65 years there was 1 liver resection per 12 cases, 65-74, 1 per 17, and ≥75, 1 per 40. 90-day mortality after liver resection increased with advancing age (<65 0.9% (26/2829), 65-74 2.8% (57/2070), ≥75 4.0% (47/1182); P < 0.001). Age was an independent risk factor for 3-year mortality. Patients 65-74 did not have adjusted mortality higher than those <65, yet age ≥75 was associated with increased overall mortality (Hazard ratio (HR) 1.47 (95% CI 1.30-1.68)) and cancer-specific mortality (HR 1.30 (95% CI 1.13-1.49)). Conclusion: Although advancing age was associated with higher rates of 90-day mortality following liver resection, 3-year mortality for patients 65-74 years was comparable to younger patients. These results will aid clinicians and patients in pre-operative decision-making. (Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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