Liver resection in elderly patients with extensive CRLM: Are we offering an adequate treatment? A propensity score matched analysis.

Autor: Di Martino M; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain; Department Hepatobiliar Surgery and Liver Transplant. A.O.R.N. Cardarelli, Napoli, Italy., Dorcaratto D; Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain. Electronic address: dorcaratto.dimitri@gmail.com., Primavesi F; Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria. Electronic address: florian.primavesi@ooeg.at., Syn N; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. Electronic address: nicholassyn@gmail.com., Blanco-Terés L; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain. Electronic address: blancotereslara@gmail.com., Dupré A; Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; Department of Surgical Oncology, Centre Léon Bérard, Lyon, France. Electronic address: aurelien.DUPRE@lyon.unicancer.fr., Piardi T; Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France; Department of Surgery, HPB Unit, Simone Veil Hospital, Troyes, France. Electronic address: tullio.piardi@gmail.com., Rhaiem R; Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France. Electronic address: rhaiem14@gmail.com., Fernández GB; Department of HBP and Liver Transplantation Surgery. University Hospital of Badajoz. INUBE (Instituto Universitario de Investigación Biosanitaria de Extremadura). University of Extremadura, Badajoz, Spain. Electronic address: gerardoblanco@unex.es., De Armas Conde N; Department of HBP and Liver Transplantation Surgery. University Hospital of Badajoz. INUBE (Instituto Universitario de Investigación Biosanitaria de Extremadura). University of Extremadura, Badajoz, Spain. Electronic address: noeliadearmasconde@gmail.com., Rodríguez Sanjuán JC; Hospital Universitario Marqués de Valdecilla, Santander, Spain. Electronic address: juancarlos.rodriguezs@scsalud.es., Santiago RF; Hospital Universitario Marqués de Valdecilla, Santander, Spain. Electronic address: rofersant@yahoo.es., Fernández-Moreno MC; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. Electronic address: mcfm89@gmail.com., Ferret G; Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain. Electronic address: gf4541@hotmail.com., Ben SL; Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain. Electronic address: santilb@msn.com., Suárez Muñoz MÁ; Hospital Universitario Virgen de la Victoria, Malaga, Spain. Electronic address: masuarez59@gmail.com., Perez-Alonso AJ; Unidad de Cirugia HBP y Trasplante Hepático, Hospital Universitario Virgen de las Nieves, Granada, Spain. Electronic address: apma85@hotmail.com., Koh YX; Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom. Electronic address: koh.ye.xin@singhealth.com.sg., Jones R; Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain. Electronic address: robert.jones@aintree.nhs.uk., Vennarecci G; Department Hepatobiliar Surgery and Liver Transplant. A.O.R.N. Cardarelli, Napoli, Italy. Electronic address: giovanni.vennarecci@aocardarelli.it., Martín-Pérez E; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain. Electronic address: elemartin2003@yahoo.es.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2022 Jun; Vol. 48 (6), pp. 1331-1338. Date of Electronic Publication: 2021 Dec 29.
DOI: 10.1016/j.ejso.2021.12.028
Abstrakt: Background: Data on the management of elderly patients with extensive colorectal liver metastases (CRLM) are scarce and conflicting. This study assesses differences in management and long-term oncological outcomes between older and younger patients with CRLM and a high Tumour Burden Score (TBS).
Methods: International multicentre retrospective study on patients with CRLM and a category 3 TBS, submitted to liver resection. Patients were divided into two groups according to their age (younger and older than 75) and were compared using propensity score matching (PSM) analysis and multivariable regression models. Differences in management and oncological outcomes including recurrence-free survival (RFS) and overall survival (OS) were assessed.
Results: The study included 386 patients, median follow-up was 48 months. The unmatched comparison revealed a higher ASA score (p = 0.035), less synchronous CRLM (47% vs 68%, p = 0.003), a lower median number of lesions (1 vs 3, p = 0.004) and less perioperative chemotherapy (CTx) (66% vs 88%, p < 0.001) in the elderly group. Despite the absence of CTx being an independent predictor of decreased RFS and OS (HR 0.760, p = 0.044 and HR 0.719, p = 0.049, respectively), the elderly group still received less CTx (OR 0.317, p = 0.001) than the younger group. After PSM (n = 100 patients), the two groups were comparable, however, CTx administration was still significantly lower in the elderly group.
Conclusion: Liver resection should be considered in patients aged 75 and older, even if they present with extensive liver disease. Despite CTx being associated with improved oncological outcomes, a large percentage of elderly patients with CRLM are undertreated.
Competing Interests: Declaration of competing interest The Authors declare that there is no conflict of interest.
(Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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