An educational tool to assist in the management of hepatic metastases in patients with colorectal cancer

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Impact of Comorbidities

Surgery in the elderly



As people age, their organs age — their hearts, kidneys and brains have been there longer. So workups are necessary for these individuals, especially smokers, to make sure that they’re going to have the lung reserve to undergo major surgery. You ensure that they have good kidney function, have stopped smoking and make sure they’re in reasonable shape because you want to minimize the complications. A smoker — especially a smoker with a 20 pack-year history — would have a higher risk for postoperative pneumonia, so you have to be more aggressive with individuals like this, telling them how important it is to work on their lungs postoperatively, use spirometers to get their lungs expanded, early ambulation even more so — getting them up and walking around. These are important aspects of any type of surgery, but especially important in liver surgery.

I take age into consideration, not merely age alone. I also consider the past medial history of the patient and obviously the condition of the other major organs in the body like the lung, the brain and the kidneys. In today’s day and age, major operations are done in the octogenarian. Patients are out there who are candidates for liver resection, but they don’t go to a surgeon. They end up seeing an oncologist who feels that a 70-year-old with two lesions in the liver is not a candidate for surgery. It’s a failure on our part to educate.


Liver regeneration in patients with diabetes

Commentator: STEVEN CURLEY, MD


We have found that if diabetes is well controlled and is kept well controlled in the postoperative period, hepatic regeneration is normal and does not regenerate at a slower rate. These patients don’t have an increased incidence or risk of liver insufficiency or liver failure as long as we maintain their blood sugar in a good range. We like to keep their blood sugar under 180 while they’re in the regenerative period, and we find that these folks fare well.


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