Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK.
Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK.
Eur J Surg Oncol. 2018 Jul;44(7):1040-1047. doi: 10.1016/j.ejso.2018.01.089. Epub 2018 Feb 6.
Concern exists regarding the use of hepatectomy to treat colorectal liver metastasis (CRLM) in octogenarians due to prior studies suggesting elevated morbidity and mortality. Cardiopulmonary exercise testing (CPET) within pre-operative assessment and enhanced recovery after surgery (ERAS) have both been shown to be associated with low morbidity and mortality in patients undergoing hepatectomy. This study sought to compare the outcomes of octogenarians with patients aged 70-79 undergoing hepatectomy for CRLM, within a center utilizing both CPET and ERAS.
Consecutive patients age 70 or older who underwent hepatectomy for CRLM at Aintree University Hospital (Liverpool,UK), between May 2008 and May 2015 were identified from a prospectively maintained cancer database. Data were extracted and comparisons drawn.
127 patients aged 70-79 years and 34 octogenarians underwent respectively 137 and 35 hepatectomy for CRLM. There was no difference in hospital stay (6 days), morbidity and mortality between the groups. OS at 1, 3 and 5 years were 86.7%, 55% and 35.8% for those aged 70-79 compared to 79.4%, 37.3% and 20.4% for the octogenarians (p=0.127). DFS at 1,3 and 5 years was 52.5%, 31.7% and 31.7% for 70-79 group compared to 46.2%, 31.5% and 16.8% for the octogenarians (p=0.838). On multivariate analysis major hepatectomy was associated with an increased risk of post-operative complications, inferior OS and DFS. Chronological age was not a predictor of postoperative complications, poorer OS or DFS.
Appropriately selected octogenarians can have similar postoperative outcomes to patients aged 70-79 when undergoing hepatectomy for CRLM using ERAS combined with CPET. This study advocates using CPET and ERAS in the selection and management of octogenarian patients with CRLM undergoing hepatectomy.
由于先前的研究表明高龄患者的发病率和死亡率较高，因此对于 80 岁以上的患者行肝切除术治疗结直肠癌肝转移（CRLM）存在一定顾虑。围手术期心肺运动测试（CPET）和术后加速康复（ERAS）都与接受肝切除术的患者的低发病率和死亡率相关。本研究旨在比较在使用 CPET 和 ERAS 的中心中，80 岁以上患者与 70-79 岁患者行肝切除术治疗 CRLM 的结果。
从一个前瞻性维护的癌症数据库中，确定 2008 年 5 月至 2015 年 5 月期间在安特里大学医院（利物浦，英国）接受 CRLM 肝切除术的 70 岁或以上的连续患者。提取数据并进行比较。
分别有 127 名 70-79 岁和 34 名 80 岁以上的患者行 137 例和 35 例 CRLM 肝切除术。两组患者的住院时间（6 天）、发病率和死亡率均无差异。70-79 岁组的 OS 为 1、3 和 5 年分别为 86.7%、55%和 35.8%，80 岁组的 OS 为 79.4%、37.3%和 20.4%（p=0.127）。70-79 岁组的 DFS 为 1、3 和 5 年分别为 52.5%、31.7%和 31.7%，80 岁组的 DFS 为 46.2%、31.5%和 16.8%（p=0.838）。多因素分析表明，大范围肝切除术与术后并发症、OS 和 DFS 不良相关。年龄并不是术后并发症、较差的 OS 或 DFS 的预测因素。
在使用 ERAS 联合 CPET 治疗 CRLM 时，适当选择的 80 岁以上患者的术后结果可与 70-79 岁患者相似。本研究主张在选择和管理接受肝切除术治疗 CRLM 的 80 岁以上患者时使用 CPET 和 ERAS。
