Abstract
Purpose
Most elderly patients with colorectal cancer have comorbidities and reduced functional reserve, which may increase their risks of postoperative morbidity and mortality, and subsequently influence the treatment choice. Therefore, this study aimed to investigate the treatment choice and compare laparoscopic and open surgery in this setting.
Methods
This retrospective study evaluated 118 patients with colorectal cancer (≥ 85 years old between January 2007 and February 2018) to determine the influence of comorbidities on treatment choice, as well as the safety and feasibility of laparoscopic surgery for these patients.
Results
The patients included 42 men (35.6%) and 106 patients (89.8%) with comorbidities. The treatments were curative resection for 90 patients and palliative surgery for 16 patients, including 5 cases of colostomy/ileostomy because of the difficulty of primary cancer resection, pneumonia, or pulmonary hypertension. Twelve patients received non-surgical treatment, including 7 patients with decreased respiratory function because of chronic obstructive pulmonary disease or pneumonia. Forty-three patients underwent open curative resection and 47 patients underwent laparoscopic curative resection, which was associated with a significantly shorter hospital stay (14 days vs. 19days, P < 0.01), a lower morbidity rate (17.0% vs. 37.2%, P = 0.035), and less blood loss (10 mL vs. 140 mL, P < 0.01). One patient in each group died during the postoperative period because of worsened pre-existing pneumonia.
Conclusion
Laparoscopic surgery was safer and less invasive than open surgery for colorectal cancer among ≥ 85-year-old patients. Pulmonary comorbidities affected the choice of non-curative surgery and may be related to the risk of postoperative mortality.
This is a preview of subscription content, log in via an institution to check access.
References
Japanese Ministry of Internal Affairs and Communications. Home page of the Statistics Bureau. Available at: https://www.e-stat.go.jp/en/stat-search/files?page=1&layout=datalist&toukei=00200524&tstat=000000090001&cycle=1&year=20180&month=12040604&tclass1=000001011678 Accessed 10 May 2018
Tokuhara K, Nakatani K, Ueyama Y, Yoshioka K, Kon M (2016) Short- and long-term outcomes of laparoscopic surgery for colorectal cancer in the elderly: a prospective cohort study. Int J Surg 27:66–71
Brierley JD, Gospodarowicz MK, Wittekind C (2017) UICC international union against cancer. TMN classification of malignant tumours, 8th edn. Wiley-Blackwell, Chichester
Sabate S, Mazo V, Canet J (2014) Predicting postoperative pulmonary complications: implications for outcomes and costs. Curr Opin Anaesthesiol 27:201–209
Baré M, Montón C, Mora L, Redondo M, Pont M, Escobar A, Sarasqueta C, Fernández de Larrea N, Briones E, Quintana JM (2017) COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain. Int J Chron Obstruct Pulmon Dis 12:1233–1241
Platon AM, Erichsen R, Christiansen CF, Andersen LK, Sværke C, Montomoli J, Sørensen HT (2014) The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery: a Danish population-based cohort study. BMJ Open Respir Res 1:e000036
Kochi M, Hinoi T, Niitsu H, Ohdan H, Konishi F, Kinugasa Y, Kobatake T, Ito M, Inomata M, Yatsuoka T, Ueki T, Tashiro J, Yamaguchi S, Watanabe M (2016) The Japan Society of Laparoscopic Colorectal Surgery. Risk factor for postoperative pneumonia in elderly patients with colorectal cancer: a sub-analysis of a large, multicenter, case-control study in Japan. Surg Today 48:756–764. https://doi.org/10.1007/s00595-018-1653-8
Miki Y, Makuuchi R, Honda S, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Yurikusa T, Tamura A, Tareshima M (2018) Prospective phase 2 study evaluating the efficacy of swallow ability screening tests and pneumonia prevention using a team approach for elderly gastric cancer. Gastric Cancer 21:353–359
Boden I, Skinner EH, Browning L, Reeve J, Anderson L, Hill C, Robertson IK, Story D, Denehy L (2017) Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blind, multicenter randomized controlled trial. BMJ 360:j5916
The Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52
van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLORII): short-term outcomes of a randomized, phase 3 trial. Lancet Oncol 14:210–218
Devoto L, Celentano V, Cohen R, Khan J, Chand M (2017) Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection. Int J Color Dis 32:1237–1242
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Nishikawa, T., Kawai, K., Emoto, S. et al. The influence of pulmonary comorbidities on treatment choice and short-term surgical outcomes among elderly patients with colorectal cancer. Int J Colorectal Dis 34, 1497–1501 (2019). https://doi.org/10.1007/s00384-019-03336-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-019-03336-9