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Surgery for Liver Metastases

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Management of Colorectal Cancers in Older People

Abstract

Life expectancy has increased significantly in recent years. Along with this even the definition of an elderly patient has been modified over the years. During the last two decades the cut-off point of 70 years became the most commonly used in literature, replacing the 65 years cut-off wider adopted in the past.

Colorectal cancer is one the most common malignant tumors in the Western world and remains the second most common cause of cancer related deaths in the United States. Up to 76% of all people affected by colorectal cancer are diagnosed between the ages of 65 and 85; and 33–50% of patients with colorectal liver metastases are 70 years old and beyond.

Over the last twenty years the number of elderly patients considered for live resection has been increasing constantly.

Nowadays, techniques in the field of hepatic surgery and peri-operative care has improved dramatically achieving mortality rates that vary between 0% and 11%, even for procedures combining colon resection with liver resection.

Recent studies published in literature showed no significant difference in postoperative complications and postoperative mortality between the age specific subgroups of patients undergoing liver resections for colorectal liver metastases. Long term survival is comparable to younger patients and a multimodality approach to metastatic disease using peri-operative chemotherapy is now established in the elderly and its use can be associated with improved results. When non resectable and only localized to the liver, colorectal liver metastases can be treated by ablative techniques such as Radiofrequency Ablation and Microwave Ablation. Such procedures, with or without the aid chemotherapy, can provide a significant improvement in overall survival.

Increasing age itself it is not a predictor of short survival therefore elderly patient affected by colorectal liver metastases should be always considered for liver resection when feasible.

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Authors and Affiliations

  1. HPB Unit, North Manchester General Hospital, Pennine Acute Trust, Manchester, M8 5RB, UK

    Nicola de’ Liguori Carino M.D. & Luigi Bonanni M.D.

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  1. Nicola de’ Liguori Carino M.D.
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  2. Luigi Bonanni M.D.
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Correspondence to Nicola de’ Liguori Carino M.D. .

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Editors and Affiliations

  1. Bank of Cyprus Oncology Centre, Acropoleos Avenue, Nicosia, 2006, Cyprus

    Demetris Papamichael

  2. St Helens Teaching Hospital, University of Liverpool, Marshalls Cross Road, St Helens, WA9 3DA, United Kingdom

    Riccardo A. Audisio

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de’ Liguori Carino, N., Bonanni, L. (2013). Surgery for Liver Metastases. In: Papamichael, D., Audisio, R. (eds) Management of Colorectal Cancers in Older People. Springer, London. https://doi.org/10.1007/978-0-85729-984-0_8

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  • DOI: https://doi.org/10.1007/978-0-85729-984-0_8

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