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

Yıl 2023, Cilt: 5 Sayı: 2, 160 - 167, 27.03.2023

Recep Erçin Sönmez

https://doi.org/10.38053/acmj.1257547

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 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.