Retrospective study of age-associated morbidity after major hepatectomy for colorectal liver metastases

As population ages, older patients are increasingly presenting for surgical management of advanced malignancies. Hepatectomy for colorectal liver metastases (CRLM) prolongs survival. A retrospective study using the American College of Surgeons National Surgical Quality Improvement dataset for hepatectomy from 2014 to 2024 investigated age-associated morbidity after major hepatectomy for CRLM. A total of 4119 patients were included: 3346 patient younger than 70 years, 663 patients aged 70 to 79 years, and 110 patients aged 80 years or older. Older patients were more likely to experience cardiac complication (p<0.001), post-hepatectomy liver failure (PHLF; p<0.001), and failure to rescue (p<0.001). No significant differences in postoperative outcomes were observed between sexes. Multivariable logistic regression analysis showed that septuagenarians had higher odds of failure to rescue than patient younger than 70 years (OR 2.36; 95% CI 1.29-4.33). PHLF (OR 2.98; 95% CI 1.69-5.25) and cardiac complications (21.75; 11.69-40.47) were associated with higher odds of failure to rescue. The authors conclude that older age was significantly associated with postoperative morbidity and failure to rescue in patients undergoing major hepatectomy for CRLM; cardiac complication and PHLF were identified as potential causes associated with failure to rescue.