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Introduction
Metastasectomy is the most effective therapy for hepatic colorectal metastases, yet the safety and efficacy of liver resection in elderly patients is not fully understood. The aim of this study was to determine the safety and efficacy of hepatic metastasectomy in elderly patients with colorectal liver metastases (CLM).
Methods
With IRB approval, a retrospective review of a hepatobiliary database was performed on consecutive patients treated with metastasectomy for CLM. Patients were stratified by age (<70 years old vs. ≥ 70). Age 70 was chosen as a breakpoint to allow for comparison to current literature. Patient and tumor characteristics as well as operative factors were compared, as were morbidity, mortality, and length of stay. Data analysis was performed using chi squared, Fisher’s exact test, student’s t, and Wilcoxon rank sum where appropriate. Survival was analyzed according to Kaplan-Meier and Cox proportional hazards and compared using the log rank test.
Results
There were 59 elderly (median age 75) and 220 non-elderly (median age 58) patients analyzed over a 13 year period. The Charlson Comorbidity Index was higher in the elderly group (mean 4.7 vs. 4.4 p=0.015). Postoperative morbidity and mortality were 52.5 and 0% vs. 48.2 and 0.9% in the elderly and non elderly groups, respectively (p=.56 and p=1.0). There was no difference in the severity of complications between the two groups (p=0.136). Length of stay was also similar between the two groups (p=0.23), however, elderly pts more likely to be discharged to a nursing facility (17.1% vs. 1.4% p=0.0002). There were no differences in median DFS (21.8 months vs. 28.9 months; p=0.07) or OS (36 months vs. 47.7 months; p=0.16) between the elderly and non-elderly groups, respectively. When analyzed as a continuous variable, age had no significant effect on OS or DFS (hazard ratio 1.012 95%CI 0.997-1.028 p=.1295 and 1.005 95% CI 0.991-1.019 p=0.470 respectively) There was no difference in patterns of recurrence (lung only, liver and extrahepatic, liver only, liver and lung, extrahepatic only) (p=0.59, p=0.97, p=0.16, p=0.29, p=0.51).
Conclusions
Hepatic metastasectomy is safe and effective for elderly patients with colorectal metastases. Age alone should not be considered a contraindication to hepatic resection, including major hepatectomy.

Age	Morbidity (%)	Mortality (%)	EBL (ml, median)	LOS (days, median)	Fong Score (median)	Transfused (%)	Major Hepatectomy (%)	Pringle (%)	Synchronous Colectomy (%)	R0 Resection (%)
≥70	52.5	0	250	7	2	54.2	52.5	37.5	15.3	81.4
<70	48.2 p=0.56	0.91 p=1.0	300 p=0.44	7 p=0.23	2 p=0.45	50.7 p=0.66	53.1 p=0.93	27.8 p=0.11	10.1 p=0.36	88.7 p=0.14