Kumari Seema, Semira Christine, Lee Margaret, Lee Belinda, Wong Rachel, Nott Louise, Shapiro Jeremy, Gibbs Peter
Medical Oncology, Westmead Hospital, Sydney, New South Wales, Australia.
Medical Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.
ANZ J Surg. 2020 May;90(5):796-801. doi: 10.1111/ans.15750. Epub 2020 Feb 18.
Colorectal cancer remains a common cancer in the western world, with liver resection being the only potentially curative option for isolated colorectal cancer liver metastases (CRCLM). Cancer is a disease of aging, with the optimum management of elderly patients with CRCLM presenting an ongoing dilemma.
We analysed the outcome of CRCLM using prospectively collected patient data from the multidisciplinary Treatment of Recurrent and Advanced Colorectal Cancer registry, collected from July 2009 to July 2018 at 12 Australian hospitals.
Of 2742 patients with metastatic colorectal cancer, liver-limited disease was present in 977 (36%) patients, of whom 338 (35%) underwent hepatic resection. Resection rates varied with age, including 186 (43%) of 428 patients aged 64 years and younger, 99 (40%) of 245 aged 65-75 years and 53 (17%) of 303 aged 76 and older (P < 0.001). The 30-day mortality rate was 0.9%. Median survival post resection also varied with age, 96 versus 89 versus 68 months (P < 0.001). In a separate analysis of the oldest patients, those aged over 80 years, where only 11% underwent resection, the median survival was 49 months.
The operative mortality for patients undergoing liver resection at Australian hospitals is low. With advancing age, the rate of liver resection of CRCLM and the post-resection survival decline. However, excellent survival outcomes can be achieved in selected elderly patients.
在西方世界，结直肠癌仍然是一种常见癌症，肝切除术是孤立性结直肠癌肝转移（CRCLM）唯一可能治愈的选择。癌症是一种与衰老相关的疾病，如何对老年CRCLM患者进行最佳管理一直是个难题。
我们使用前瞻性收集的患者数据，分析了CRCLM的治疗结果，这些数据来自2009年7月至2018年7月在澳大利亚12家医院收集的多学科复发性和晚期结直肠癌治疗登记系统。
在2742例转移性结直肠癌患者中，977例（36%）存在肝局限性疾病，其中338例（35%）接受了肝切除术。切除率随年龄而异，64岁及以下的428例患者中有186例（43%），65 - 75岁的245例患者中有99例（40%），76岁及以上的303例患者中有53例（17%）（P < 0.001）。30天死亡率为0.9%。切除术后的中位生存期也随年龄而异，分别为96个月、89个月和68个月（P < 0.001）。在对最年长患者（年龄超过80岁）的单独分析中，只有11%的患者接受了切除术，中位生存期为49个月。
澳大利亚医院接受肝切除术的患者手术死亡率较低。随着年龄的增长，CRCLM的肝切除率和切除术后生存率下降。然而，部分老年患者仍可获得良好的生存结果。
