Onco-surgical management of colo-rectal liver metastases in older patients: a new frontier in the 3rd millennium

Colorectal cancer (CRC) is one the most common malignant tumors in industrialized countries today. Over half of all cancers are currently diagnosed in elderly patients, and 76% of all colorectal cancer patients are diagnosed between 65 and 85 years old. Elderly patients are less likely to undergo curative surgery, and less likely to be offered the option of metastasectomy when colorectal liver metastases (CLM) are present. Hepatic resection has become the standard care for the treatment of isolated CLM. However, in studies reporting resection of CLM only 8-20% of the patients are older than 70 years. When balancing the benefits of surgical resection of liver metastases against the potential risks of surgery, many clinicians are still reluctant to advise in favor of surgical treatment in the elderly. Factors other than age should also be considered when evaluating surgical risk in the elderly, for example, conditions such as heart disease and diabetes have been shown to induce life-threatening postoperative complications. Age alone need not be a contraindication to aggressive surgical therapy in this group, rather, appropriate selection criteria based on tumor characteristics and general medical fitness, similar to those used for younger patients, should be applied.