Department of Digestive Surgery and Surgical Oncology - Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris XIII, 125 rue de Stalingrad, 93000, Bobigny, France.
Department of Digestive, Oncological and Metabolic Surgery - Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
Surg Endosc. 2019 Nov;33(11):3704-3710. doi: 10.1007/s00464-019-06663-8. Epub 2019 Jan 22.
Hepatectomy remains the only curative option in patients presenting with colorectal liver metastases (CLM). Although laparoscopic approach has improved postoperative morbidity and mortality rates, its suitability for patients of all age groups has yet to be confirmed. The aim of this study was to analyze postoperative outcomes following laparoscopic liver resection (LLR) in different age groups of patients presenting with CLM.
All patients who underwent LLR for CLM from 2008 to 2017 were reviewed. Patients were divided into four age groups: < 55, 55-65 years, 65-75 and > 75 years. Baseline and intraoperative characteristics as well as postoperative morbidity and mortality were compared between all four groups.
Overall, 335 patients were included with 34 (10%), 113 (34%), 136 (41%) and 52 (15%) in < 55, 55-65, 65-75 and > 75 years subgroups. Baseline characteristics were similar between all four groups except for elevated pressure, dyslipidemia and ASA score which were higher in older patients. Regarding surgical procedures, major hepatectomy, uni- or bisegmentectomy and wedge resection were performed in 122 (36%), 87 (26%) and 126 (38%) patients, respectively, with no significant differences between age groups. Overall, 90-day postoperative mortality rate was nil and postoperative morbidity was similar between all four groups except for biliary fistula occurrence, which was higher in < 55 years patients (p = 0.006).
Short-term postoperative outcome following LLR for CLM does not seem to be affected by age. Curative laparoscopic treatment should therefore be considered whenever possible, regardless of patient age.
肝切除术仍然是结直肠肝转移（CLM）患者的唯一治愈方法。尽管腹腔镜方法降低了术后发病率和死亡率，但它是否适用于所有年龄段的患者尚待证实。本研究旨在分析不同年龄段 CLM 患者行腹腔镜肝切除术（LLR）的术后结果。
回顾 2008 年至 2017 年间行 LLR 治疗 CLM 的所有患者。将患者分为四组年龄：<55 岁、55-65 岁、65-75 岁和>75 岁。比较四组患者的基线和术中特征以及术后发病率和死亡率。
共纳入 335 例患者，其中<55 岁、55-65 岁、65-75 岁和>75 岁患者分别为 34 例（10%）、113 例（34%）、136 例（41%）和 52 例（15%）。除了高血压、血脂异常和 ASA 评分较高外，四组患者的基线特征相似。在手术方式上，分别有 122 例（36%）、87 例（26%）和 126 例（38%）患者行广泛肝切除术、单或双段切除术和楔形切除术，各年龄组之间无显著差异。总体而言，90 天术后死亡率为零，四组患者的术后发病率相似，但<55 岁患者的胆瘘发生率较高（p=0.006）。
行 LLR 治疗 CLM 的短期术后结果似乎不受年龄影响。因此，只要有可能，应考虑对患者进行根治性腹腔镜治疗，而不考虑患者年龄。
