Is simultaneous resection of colorectal cancer and synchronous liver metastases safe in the elderly?: a single-center, retrospective cohort study

Introduction: The elderly population with liver metastasis from colorectal cancer has been increasing. But the safety of simultaneous resections of colorectal cancer and synchronous liver metastases (SCRLM) in the elderly is not established. Methods: This single-center retrospective cohort study compared postoperative outcomes, Overall Survival(OS) and Disease-Free survival(DFS) after simultaneous colorectal and hepatic resections in different age groups. Clinicopathologic data, treatments, and postoperative outcomes from patients who underwent simultaneous colorectal and hepatic resections at National Cancer Center, Korea from 2001-2014 were reviewed. Results: 443 patients(287 young patients < = 65 years old, 122 patients between 66 and 75 years old, and 34 elderly patients > 75 years old) underwent simultaneous resections of colorectal cancer and liver metastases. Young patients had lower ASA score (ASA score 1 in 46% versus 15.6% and 20.6%). The elderly less often underwent major hepatectomy (51.6%, 48.4% versus 26.5%, p< 0.05). Mortality and severe morbidity were similar in each age group, but for minor hepatectomy, the elderly more often experienced severe morbidity (12.3% versus 8.7% and 0%, p < 0.05). The overall survival showed a significant difference in favor of the younger patients (40.1% versus 32.4%, p = 0.005). However, with regard to disease-free survival, there was no significant difference between elderly and younger patients. Conclusion: Simultaneous resection of SCRLM is relatively safe, and even major hepatic resection can be recommented in carefully selected elderly patients.