Surgical Endoscopy

, Volume 27, Issue 1, pp 19–30 | Cite as

Laparoscopic versus open colorectal resection in the elderly population

  • Katherine Grailey
  • Sheraz R. Markar
  • Alan Karthikesalingam
  • Rima Aboud
  • Paul Ziprin
  • Omar FaizEmail author



Elderly patients are often regarded as high-risk patients for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The aim of this systematic review and pooled analysis was to review the current data published regarding the differences in operative outcomes of laparoscopic and open surgery in the elderly population.


A systematic literature search of Medline, Embase, Web of Science, and Cochrane databases was performed. Studies that compared outcome following laparoscopic and open colorectal resections in the elderly (≥70) population were included. Primary outcomes were operative death, anastomotic leak, pneumonia, length of hospital stay, and return to bowel function. Secondary outcomes were operative time, intraoperative blood loss, postoperative cardiac morbidity, ileus, and postoperative wound infection.


The results of this systematic review and pooled analysis demonstrate the safety and potential benefits of laparoscopic colorectal resection in the elderly population. The latter include reduction in length of hospital stay, intraoperative blood loss, incidence of postoperative pneumonia, time to return of normal bowel function, incidence of postoperative cardiac complications, and wound infections.


The results of this pooled analysis demonstrate the potential short-term advantages of laparoscopic colorectal resection in the elderly population. Further studies are required to examine the long-term survival following laparoscopic and open colorectal resections in the elderly population.


Laparoscopy Colorectal resection Elderly 



We are grateful for support in part from the NIHR Biomedical Research Centre funding scheme.


Kate Grailey, Sheraz R. Markar, Alan Karthikesalingam, Rima Aboud, Paul Ziprin, and Omar Faiz have no conflicts of interest or financial ties to disclose.


  1. 1.
    Creditor M (1993) Hazards of hospitalization of the elderly. Ann Intern Med 118:219–223PubMedGoogle Scholar
  2. 2.
    Weber DM (2003) Laparoscopic surgery: an excellent approach in elderly patients. Arch Surg 138:1083–1088CrossRefPubMedGoogle Scholar
  3. 3.
    Panis Y (2000) Laparoscopic surgery for benign colorectal diseases. J Chir (Paris) 137:261–267Google Scholar
  4. 4.
    Meza R, Jeon J, Renehan AG, Luebeck EG (2010) Colorectal cancer incidence trends in the United States and United Kingdom: evidence of right- to left-sided biological gradients with implications for screening. Cancer Res 70:5419–5429CrossRefPubMedGoogle Scholar
  5. 5.
    Reza M, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928CrossRefPubMedGoogle Scholar
  6. 6.
    Hong D, Lewis M, Tabet J, Anvari M (2002) Prospective comparison of laparoscopic versus open resection for benign colorectal disease. Surg Laparosc Endosc Percutan Tech 12:238–242CrossRefPubMedGoogle Scholar
  7. 7.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRefPubMedGoogle Scholar
  8. 8.
    Vignali A, Di Palo S, Tamburini A, Radaelli G, Orsenigo E, Staudacher C (2005) Laparoscopic vs. open colectomies in octogenarians: a case-matched control study. Dis Colon Rectum 48:2070–2075CrossRefPubMedGoogle Scholar
  9. 9.
    Tei M, Ikeda M, Haraguchi N, Takemasa I, Mizushima T, Ishii H, Yamamoto H, Sekimoto M, Doki Y, Mori M (2009) Postoperative complications in elderly patients with colorectal cancer comparison of open and laparoscopic surgical procedures. Surg Laparosc Endosc Percutan Tech 19:488–492CrossRefPubMedGoogle Scholar
  10. 10.
    Tuech JJ, Pessaux P, Rouge C, Regenet N, Bergamaschi R, Arnaud JP (2000) Laparoscopic vs. open colectomy for sigmoid diverticulitis: a prospective comparative study in the elderly. Surg Endosc 14:1031–1033CrossRefPubMedGoogle Scholar
  11. 11.
    Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM (2000) Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study. Dis Colon Rectum 43:326–332CrossRefPubMedGoogle Scholar
  12. 12.
    Stewart BT, Stitz RW, Lumley JW (1999) Laparoscopically assisted colorectal surgery in the elderly. Br J Surg 86:938–941CrossRefPubMedGoogle Scholar
  13. 13.
    Sklow B, Read T, Birnbaum E, Fry R, Fleshman J (2003) Age and type of procedure influence the choice of patients for laparoscopic colectomy. Surg Endosc 17:923–929CrossRefPubMedGoogle Scholar
  14. 14.
    Senagore A, Madbouly K, Fazio V, Duepree H, Brady K, Delaney C (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138:252–256CrossRefPubMedGoogle Scholar
  15. 15.
    Lin KL, Chang TC, Huang J, Lin BR, Liang JT (2010) Laparoscopic colectomy for nonagenarians, preliminary experience in National Taiwan University Hospital. J Soc Colon Rectal Surgeon (Taiwan) 21:177–186Google Scholar
  16. 16.
    Lian L, Kalady M, Geisler D, Kiran R (2010) Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians. Surg Endosc 24:2039–2043CrossRefPubMedGoogle Scholar
  17. 17.
    Law WL, Chu KW, Tung P (2002) Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg 195:768–773CrossRefPubMedGoogle Scholar
  18. 18.
    Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V (2008) Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 51:296–300CrossRefPubMedGoogle Scholar
  19. 19.
    Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev (2):CD003432Google Scholar
  20. 20.
    Irvin TT (1998) Prognosis of colorectal cancer in the elderly. Br J Surg 75:419–421CrossRefGoogle Scholar
  21. 21.
    Fujita T, Sakurai K (1995) Multivariate analysis of risk factors for postoperative pneumonia. Am J Surg 169:304–307CrossRefPubMedGoogle Scholar
  22. 22.
    Brooks-Brunn J (1997) Predictors of postoperative pulmonary complications following abdominal surgery. Chest 111:563–571CrossRefGoogle Scholar
  23. 23.
    Garibaldi R, Britt MR, Coleman ML, Reading JC, Pace NL (1981) Risk factors for postoperative pneumonia. Am J Med 70:677–680CrossRefPubMedGoogle Scholar
  24. 24.
    Iwamoto K, Ichiyama S, Shimokata K, Nakashima N (1993) Postoperative pneumonia in elderly patients: incidence and mortality in comparison with younger patients. Intern Med 32:274–277CrossRefPubMedGoogle Scholar
  25. 25.
    Lamont CT, Sampson S, Matthias R, Kane R (1983) The outcome of hospitalization for acute illness in the elderly. J Am Geriatr Soc 31:282–288PubMedGoogle Scholar
  26. 26.
    Gill TM, Allore HG, Gahbauer EA, Murphy TE (2010) Change in disability after hospitalization or restricted activity in older persons. JAMA 304:1919–1928CrossRefPubMedGoogle Scholar
  27. 27.
    Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, Gravenstein JS (2008) Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 108:18–30CrossRefPubMedGoogle Scholar
  28. 28.
    Kojima Y, Narita M (2006) Postoperative outcome among elderly patients after general anesthesia. Acta Anaesthesiol Scand 50:19–25CrossRefPubMedGoogle Scholar
  29. 29.
    Kirkbride DA, Parker JL, Williams GD, Buggy DJ (2001) Induction of anesthesia in the elderly ambulatory patient: a double-blinded comparison of propofol and sevoflurane. Anesth Analg 93:1185–1187CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Katherine Grailey
    • 1
  • Sheraz R. Markar
    • 1
  • Alan Karthikesalingam
    • 3
  • Rima Aboud
    • 1
  • Paul Ziprin
    • 1
    • 2
  • Omar Faiz
    • 1
    • 2
    • 4
    Email author
  1. 1.Academic Surgical UnitSt. Mary’s Hospital, Imperial College Healthcare NHS TrustLondonUK
  2. 2.Division of Surgery and CancerImperial College LondonLondonUK
  3. 3.Department of Vascular SurgerySt George’s HospitalLondonUK
  4. 4.St Marks HospitalLondonUK

Personalised recommendations