Age Is Not a Limit: Postoperative Outcomes in Elderly Patients With Colorectal Liver Metastases

BACKGROUND: Most colorectal cancers are diagnosed in patients aged 65 years and older, with nearly 50% developing liver metastases (CRLM). This study explores postoperative and oncologic outcomes in elderly and very elderly patients with CRLM who receive curative-intent treatment. METHODS: A retrospective analysis of patients with CRLM who underwent surgical resection assessed associations with clinical outcomes. Groups were stratified by age at hepatic metastasectomy, defined as adults < 65 years, elderly 65-75 years, and very elderly > 75 years. RESULTS: We identified 346 patients, including 95 (27%) elderly and 38 (11%) very elderly patients. These patients had more medical comorbidities but comparable functional status. Elderly and very elderly patients had more right-sided tumors (p < 0.001), more pN1 disease (p = 0.009), and more often found to have metachronous liver metastases (p < 0.001). Significantly fewer elderly and very elderly patients received systemic treatment (p < 0.001). All groups underwent similar operative management with no differences in 30-day readmission, reoperation, and complication rates. Recurrence-free (p = 0.232) and overall survival (p = 0.418) were similar across groups. Age was not significantly associated with survival on univariate analysis. CONCLUSION: Well-selected elderly and very elderly patients can undergo hepatic metastasectomy without increased postoperative morbidity. Despite receiving less systemic treatment, these patients can achieve similar oncologic outcomes to adults.