Hepatobiliary Centre, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, University Paris-Sud, Unité Mixte de Recherche S 776, France.
Br J Surg. 2010 Mar;97(3):366-76. doi: 10.1002/bjs.6889.
This study evaluated the outcome of liver surgery for colorectal metastases (CLM) in patients over 70 years old in a large international multicentre cohort.
Among 7764 patients who had resection of CLM, 999 (12.9 per cent) were aged 70-75 years, 468 (6.0 per cent) were aged 75-80 years and 157 (2.0 per cent) were at least 80 years old. Elderly patients were compared with the younger population.
Multinodular and bilateral metastases were less common in elderly than in younger patients (P < 0.001). Preoperative chemotherapy was used less frequently and more limited surgery was performed (P < 0.001). Sixty-day postoperative mortality and morbidity rates were 3.8 and 32.3 per cent respectively, compared with 1.6 and 28.7 per cent in younger patients (both P < 0.001). Three-year overall survival was 57.1 per cent in elderly and 60.2 per cent in younger patients (P < 0.001), and was similar among patients aged 70-75, 75-80 or at least 80 years (57.8, 55.3 and 54.1 per cent respectively; P = 0.160). Independent predictors of survival were more than three metastases, bilateral metastases, concomitant extrahepatic disease and no postoperative chemotherapy.
Liver resection for CLM in elderly patients can achieve a reasonable 3-year survival rate, with an acceptable morbidity rate. There should be no upper age limit but risk factors may help predict potential benefit.
本研究在一个大型国际多中心队列中评估了 70 岁以上患者结直肠癌肝转移（CLM）的肝切除术结果。
在接受 CLM 切除术的 7764 例患者中，999 例（12.9%）年龄为 70-75 岁，468 例（6.0%）年龄为 75-80 岁，157 例（2.0%）年龄至少 80 岁。将老年患者与年轻患者进行比较。
老年患者的多发病灶和双侧转移较年轻患者少见（P < 0.001）。术前化疗的应用频率较低，手术范围也较小（P < 0.001）。术后 60 天死亡率和发病率分别为 3.8%和 32.3%，而年轻患者分别为 1.6%和 28.7%（均 P < 0.001）。老年患者的 3 年总生存率为 57.1%，年轻患者为 60.2%（P < 0.001），70-75 岁、75-80 岁或至少 80 岁的患者生存率相似（分别为 57.8%、55.3%和 54.1%；P = 0.160）。生存的独立预测因素是多于三个转移灶、双侧转移、合并肝外疾病和无术后化疗。
老年患者结直肠癌肝转移的肝切除术可获得合理的 3 年生存率，且发病率可接受。肝切除术不应有年龄上限，但危险因素可能有助于预测潜在获益。
