Hepatocellular cancer and colorectal liver metastasis treatment in the older population

Abstract

More than 60% of patients with primary and secondary liver tumors are older than 65 years. Thanks to improvements in radiological staging, anesthesia, surgical technique, and perioperative care it is possible to offer complex liver surgery to older patients. However, chronological age or functional status alone should not be a contraindication for multimodal radical treatment in older patients. Fit patients, according to the Comprehensive Geriatric Assessment, should be qualified for the same treatment as younger patients to ensure the same outcomes. Prefrail patients should undergo prehabilitation, and be reevaluated. Frail patients should be discussed in an oncogeriatric meeting. All patients with liver malignant tumors must be operated on in high-volume hospitals by an experienced surgeon. The introduction of parenchymal sparing surgery (instead of a major resection) in combination with other treatment tools, minimal invasive techniques, and enhanced postoperative recovery demonstrated being beneficial for older patients. In particular, frail, older patients can benefit from the wide variety of treatment options.