Neo-adjuvant treatment for metastatic colon cancer in geriatric patients followed by simultaneous hepatic resection: A case report Sotiropoulos GC, Machairas N, Stamopoulos P, Kostakis ID, Tsaparas P, Karampeazis A, Kouraklis G. 2nd Department of Propedeutic Surgery, University of Athens Medical School, Athens, Greece Introduction: Colonic cancer is the most common type of gastrointestinal cancer diagnosed in men and women in developed countries. Although symptomatic colonic cancer is treated surgically in most cases of aged patients, management of metastatic colonic cancer in the elderly is debatable. We report on an 85 year-old Caucasian male patient with a metastatic to the liver colon cancer that was treated with neo-adjuvant chemotherapy and surgery. Case description: An 85 year-old Caucasian male with medical history of chronic lymphocytic leukemia presented to our hospital with anemia and fatigue. Radiologic imaging revealed an ascending colon lesion with synchronous multiple (n=3; 5x4cm Seg. IVa, 3.4x2cm Seg. VII and 5x4.5cm Seg IVb) metastatic hepatic lesions. Histology from colonoscopy biopsies confirmed the existence of colonic adenocarcinoma. The patient received neo-adjuvant treatment (2 cycles with FOLFIRI – AVASTIN and AVASTIN alone) with favorable results. The patient experienced a 40% downsizing of the hepatic metastases according to the RECIST criteria. He underwent right colectomy with simultaneous hepatic resection of the 2 metastatic lesions (Seg IVb and VII) and intra-operative radio-ablation of the third one (Seg IVb). Postoperative course was uneventful and the patient was discharged on postoperative day eight. Histology revealed a pT2N0 (0/47 lymph nodes) M1 (hepar) adenocarcinoma. He received 4 sessions of chemotherapy and is in good condition without clinical evidence of recurrence 9 months postoperatively. Figure 1: Magnetic resonance imaging of liver metastases in segments IVa (a), VII and VIb (b) before neo-adjuvant treatment; operative specimens of liver segment VII (c ), and of metastasectomy of segment VIb (d). Discussion: Limited physiologic reserve and tolerance of therapy represent a big challenge in treating elderly patients with advanced colorectal cancer.  Treatment decisions should be made based on functional status, the presence of co-morbidities, and consideration of drug-specific toxicities that can be aggravated in older individuals due to decreased functional reserve. This case underlines the feasibility of the full oncologic approach and major surgical procedures in the elderly with the precondition of careful patient selection. a b c d