Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis

Nicola De’Angelis, Capucine Baldini, Raffaele Brustia, Patrick Pessaux, Daniele Sommacale, Alexis Laurent, Bertrand Le Roy, Vania Tacher, Hicham Kobeiter, Alain Luciani, Elena Paillaud, Thomas Aparicio, Florence Canuï-Poitrine, Evelyne Liuu

    Résultats de recherche: Contribution à un journalArticleRevue par des pairs

    21 Citations (Scopus)

    Résumé

    Objective The present study explored the existing literature to describe the outcomes of surgical and regional treatments for colorectal cancer metastases (mCRC) in older patients. Methods A literature search was conducted in PubMed, EMBASE, Cochrane and ClinicalTrials.gov for studies published since 2000 that investigated the short- and long-term outcomes of regional treatments (surgical or non-surgical) for mCRC in patients aged ≥65 years. Pooled data analyses were conducted by calculating the risk ratio (RR), mean differences (MD) and hazard ratio (HR) between older and younger patients or between two different approaches in older patients. Results After screening 266 articles, 29 were included in this review. These studies reported the outcomes of surgery (n = 19) and non-surgical local ablation treatments (n = 3) for CRC metastases in older vs. younger patients or compared the outcomes of different interventions in older patients (n = 7). When comparing older vs. younger patients undergoing liver surgery for mCRC, pooled data analysis showed higher postoperative mortality [RR = 2.53 (95%CI: 2.00–3.21)] and shorter overall survival [HR = 1.17 (95%CI: 1.07–1.18)] in older patients, whereas no differences in operative outcomes, postoperative complications and disease-free survival were found. When comparing laparoscopy vs. open surgery for liver resection in older mCRC patients, laparoscopy was associated with fewer postoperative complications [RR = 0.27 (95%CI: 0.10–0.73)]. Conclusion Liver resection for mCRC should not be disregarded a priori in older patients, who show similar operative and postoperative outcomes as younger patients. However, clinicians should consider that they are at increased risk of postoperative mortality and have a worse overall survival, which may reflect comorbidities and frailty.

    langue originaleAnglais
    Numéro d'articlee0230914
    journalPLoS ONE
    Volume15
    Numéro de publication4
    Les DOIs
    étatPublié - 1 avr. 2020

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