Mowbray Nicholas George, Chin Carven, Duncan Patricia, O'Reilly David, Kaposztas Zsolt, Junnarkar Sameer, Kumar Nagappan
Cardiff Liver Unit, University Hospital of Wales, Cardiff, UK.
Cardiff University School of Medicine, Cardiff, UK.
Ann Hepatobiliary Pancreat Surg. 2021 Feb 28;25(1):18-24. doi: 10.14701/ahbps.2021.25.1.18.
BACKGROUNDS/AIMS: As populations age, an increased incidence of colorectal cancer will generate an increase in colorectal cancer liver metastases (CRLM). In order to guide treatment decisions, this study aimed to identify the contemporary complication rates of elderly patients undergoing liver resection for CRLM in a, centralised, UK centre.
All patients undergoing operative procedures for CRLM between January 2013 and January 2019 were included. Patient, tumour and operative data were analysed, including the prognostic marker; tumour burden score.
339 operations were performed on 289 consecutive patients with CRLM (272 patients ＜75 years old, 67 patients ≥75 years old). Median age was 66 years (range 20-93). There was no difference in major complication rates between the two age cohorts (6.65 vs. 6.0%, =0.847) or operative mortality (1.1% vs. 1.4%, =0.794). Younger patients had higher R1 resection rates (20.4% vs. 4.5%, =0.002) and post-operative chemotherapy rates (60.3% vs. 35.8%, < 0.001). The 1, 3 and 5-year OS was 90.2%, 70.5% and 52.3% respectively, median 70 months, with no difference between age cohorts (=0.772). Tumour Burden score and operation type were independent predictors of overall survival.
Liver resection for CRLM in patients 75 years and older is feasible, safe and confers a similar 5-year survival rate to younger patients. The current outcomes from surgery are better than historical datasets.
背景/目的：随着人口老龄化，结直肠癌的发病率上升，这将导致结直肠癌肝转移（CRLM）的发生率增加。为了指导治疗决策，本研究旨在确定在英国一家中心医院接受CRLM肝切除术的老年患者的当代并发症发生率。
纳入2013年1月至2019年1月期间所有接受CRLM手术的患者。分析患者、肿瘤和手术数据，包括预后标志物；肿瘤负荷评分。
对289例连续性CRLM患者进行了339例手术（272例患者年龄＜75岁，67例患者年龄≥75岁）。中位年龄为66岁（范围20 - 93岁）。两个年龄组的主要并发症发生率（6.65%对6.0%，P = 0.847）或手术死亡率（1.1%对1.4%，P = 0.794）无差异。年轻患者的R1切除率较高（20.4%对4.5%，P = 0.002）和术后化疗率较高（60.3%对35.8%，P ＜0.001）。1年、3年和5年总生存率分别为90.2%、70.5%和52.3%，中位生存期为70个月，年龄组之间无差异（P = 0.772）。肿瘤负荷评分和手术类型是总生存的独立预测因素。
75岁及以上患者的CRLM肝切除术是可行、安全的，且5年生存率与年轻患者相似。目前的手术结果优于历史数据集。
