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21-24 Five-year overall survival rates in these studies were highly variable and ranged between 9% and 54.8%.21-24 In 2 of these studies, long-term outcomes were compared between young and older patients, showing no differences between the groups.21, 24 In all of these studies, an age of 40 years was used to define the young patient group, and therefore we decided to use the same cutoff point in the current study. To our knowledge, our study is the first describing long-term outcomes after hepatic resection for colorectal metastases in patients ��40 years. The trend to lower overall survival rates after hepatectomy for colorectal metastases in patients aged ��40 years was rather surprising. Often, young patients have a better performance status, with fewer cardiovascular and pulmonary comorbidities, compared with older patients. As a result, young patients can in general http://www.selleck.cn/products/pfi-2.html be treated with more aggressive preoperative chemotherapy regimens, and in case of disease recurrence, young patients are more often candidates for repeat surgery. In the current study, before hepatectomy young patients were indeed treated with significantly more cycles of systemic chemotherapy; however, postoperative mortality and morbidity rates were comparable between the groups. It is noteworthy that mean follow-up periods did not differ between the groups (36 months in the young patient group vs 39 months in the group of older patients, P = .60). Importantly, although a trend to lower overall survival rates http://www.selleckchem.com/products/epacadostat-incb024360.html was observed in younger patients, the 5-year survival rate of 33% still compares favorably with that observed with treatment by chemotherapy alone (5-year overall survival rate http://www.selleckchem.com/products/MG132.html it is at the limit of the scope of our study, that younger patients seek medical attention at a later moment when their disease is already in a more advanced stage. In addition, the difference between young patients and older patients might also be because of different mechanisms of carcinogenesis and subsequently, different aggressiveness. In a study performed by Lin et al, evaluating outcome in patients with colorectal cancer younger than 40 years, 90% of patients presented with Dukes C or D tumors at the moment of diagnosis.22 Furthermore, the authors reported a significantly poorer prognosis for patients with Dukes C or D colorectal malignancies as compared with Dukes B tumors.22 That younger patients present with colorectal malignancies in a more advanced disease stage, with more often poorly differentiated tumor grades, was confirmed by 2 recent studies.