Abstracts of the Association of Upper Gastrointestinal Surgeons of Great Britain and Irelandстатья из журнала
Аннотация: Background: Elderly patients in the English National Health Service (NHS) are less likely to undergo liver resection (LR) for colorectal cancer liver metastases (CRCLM) than younger patients.Much of the current evidence in the literature on the outcomes of liver resection for CRC liver metastases in the elderly population is from single-centre studies and hampered by a long recruitment period.The aim of this population based study was to describe the outcomes of elderly patients undergoing resection of CRCLM in comparison to younger patients, on a national scale in a recent cohort.Methods: Data from the National Bowel Cancer Audit (NBOCA) on patients diagnosed with primary CRC undergoing major CRC resection between 1 st April 2010 and 31 st March 2016 in the English NHS, were linked to the Hospital Episode Statistics (HES) database.HES records were searched for codes indicating a liver related procedure.The Cox-proportional hazards model was used to evaluate the impact of patient, tumour and surgical characteristics on 90-day mortality and 3-year mortality.The model for 3-year survival additionally included interactions between epoch (0-90 days after surgery vs 90-days-3-years after surgery) allowing risk factors to have a different effect over time.Results: There were 3252 out of 6081 patients undergoing liver resection aged ≥65 years.Combined ablation and portal vein embolisation were used less frequency in the elderly.90-day mortality increased with advancing age (<65 0.9% (26/2829), 65-74 2.8% (57/2070), ≥75 4.0% (47/1182); P < 0.001).On adjusted analysis, compared to patients <65, both patients 65-74 (OR 2.96 (95% CI 1.75-5.03))and those ≥75 (OR 4.65 (95% CI 2.68-8.07))had an increased risk of 90-day mortlaity.Three-year cancer-specific survival (<65, 68%, 65-74, 67%, ≥75, 63%) and overall survival (<65, 60%, 65-74, 56%, ≥75, 50%) decreased with advancing age.In adjusted analysis, age 65-74 was associated with increased risk of overall mortality (hazard ratio (HR) 1.14 (95% CI 1.02-1.27))but not cancer-specific mortality )).Age ≥75 was associated with both inferior overall mortality (HR 1.47 (95% CI 1.30-1.68))and CSS (HR 1.30 (95% CI 1.13-1.49)).Conclusions: This is the largest study to date reporting the outcomes of liver resection in the elderly population.It has shown that although elderly patients have higher rates of post-operative morbidity and mortality following liver resection than their younger counterparts, the long term outcomes for selected patients, even those over the age of 75 years, can be good.Judicious patient selection, pre-optimisation and increased use of parenchyma sparing techniques may further improve outcomes in the elderly cohort.
Год издания: 2017
Авторы: Abigail Vallance, Alastair L. Young, Jan Vandermeulen, Angela Kuryba, James Hill, Kate Walker, P. Lodge, Patrick Casey, Alexios Dosis, Catherine Bell, Chris Ball, Jeremy Ward, Paul Turner, Ravindra Daté, Vinutha Shetty, Kishore Pursnani, Mark Halls, Federica Cipriani, Giammauro Berardi, Leonid Barkhatov, Panagiotis Laïnas, Mathieu D’Hondt, Fernando Rotellar, Ibrahim Dagher, Luca Aldrighetti, Roberto Troisi, Bjørn Edwin, Mohammed Hilal, John M. Findlay, Stefan Antonowicz, Ashvina Segaran, Alexa Zhang, Jihène El Kafsi, Kevin M. Bradley, Richard Gillies, Mark R. Middleton, Nicholas Maynard, Dimitri J. Pournaras, Demelza Vinnicombe, Laura Hancox, R. H. Brown, Matthew Mason, Alan Osborne, Dan Titcomb, I. G. Finlay, Hamish Noble, David Mahon, Richard Welbourn, Mavis Orizu, Andrew McMaster, Kyle Brogan, Anna Sheldon, Anton Buter, Joanna Gray, Vivienne Gough
Издательство: Oxford University Press
Источник: British journal of surgery
Ключевые слова: Clinical practice guidelines implementation
Другие ссылки: British journal of surgery (PDF)
British journal of surgery (HTML)
PubMed (HTML)
British journal of surgery (HTML)
PubMed (HTML)
Открытый доступ: bronze
Том: 104
Выпуск: Supplement_7
Страницы: 5–68