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Techniques in Coloproctology

, Volume 20, Issue 3, pp 153–162 | Cite as

Laparoscopic colorectal resection versus open colorectal resection in octogenarians: a systematic review and meta-analysis of safety and efficacy

  • Y. LiEmail author
  • S. Wang
  • S. Gao
  • C. Yang
  • W. Yang
  • S. Guo
Original Article

Abstract

Octogenarians are more often viewed as high-risk surgical candidates. This increased risk is attributed to an age-related decline in physical function and reserve capacity coupled with the presence of various underlying diseases. There are no current guidelines or consensus on the optimal treatment strategy for this cohort of complex patients. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of laparoscopic colorectal resection versus open colorectal resection in octogenarians. The meta-analysis was conducted following all aspects of the Cochrane Handbook for Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic literature review was carried out using the following databases: MEDLINE, Embase, PubMed, the Cochrane Library, Google Scholar and OVID. Only studies comparing outcome of laparoscopic and open colorectal resections in the elderly population (≥80 years) were selected. The data collected included the patient demographics, interventions, observed outcome and sources of bias. When performing the statistical analysis, we used the odds ratio for categorical variables and the weighted mean difference for continuous variables. The results of this systematic review and pooled analysis demonstrated the safety and potential benefits of laparoscopic colorectal resection in octogenarians. LC can reduce the length of hospital stay, intraoperative blood loss, time to return of normal bowel function, and incidence of postoperative pneumonia, wound infection, and postoperative ileus.

Keywords

Laparoscopic colorectal resection Open colorectal resection Octogenarians Systematic review Meta-analysis 

Notes

Acknowledgments

The present study was supported by grants from the Development Center for Medical Science and Technology, Ministry of Health, PR China (No. W2013R02) and Shanxi Cancer Hospital and Institute (No. 201102).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Nakamura T, Sato T, Miura H et al (2014) Feasibility and outcomes of surgical therapy in very elderly patients with colorectal cancer. Surg Laparosc Endosc Percutan Tech 24:85–88CrossRefPubMedGoogle Scholar
  2. 2.
    Merlin F, Prochilo T, Tondulli L, Kildani B, Beretta GD (2008) Colorectal cancer treatment in elderly patients: an update on recent clinical studies. Clin Colorectal Cancer 7:357–363CrossRefPubMedGoogle Scholar
  3. 3.
    Cheung HY, Chung CC, Fung JT, Wong JC, Yau KK, Li MK (2007) Laparoscopic resection for colorectal cancer in octogenarians: results in a decade. Dis Colon Rectum 50:1905–1910CrossRefPubMedGoogle Scholar
  4. 4.
    Kozman MA (2012) Laparoscopic colorectal surgery is safe and may be beneficial in patients eighty years of age and over. Open J Gastroenterol 2:76–80CrossRefGoogle Scholar
  5. 5.
    Seshadri PA, Mamazza J, Schlachta CM, Cadeddu MO, Poulin EC (2001) Laparoscopic colorectal resection in octogenarians. Surg Endosc 15:802–805CrossRefPubMedGoogle Scholar
  6. 6.
    Soma T, Sugano M, Kawasaki C, Tsuji M, Fukui I (2014) Colorectal resection in nonagenarians: effectiveness of laparoscopic surgery. Asian J Endosc Surg 7:222–226CrossRefPubMedGoogle Scholar
  7. 7.
    Hatakeyama T, Nakanishi M, Murayama Y et al (2013) Laparoscopic resection for colorectal cancer improves short-term outcomes in very elderly colorectal cancer patients. Surg Laparosc Endosc Percutan Tech 23:532–535CrossRefPubMedGoogle Scholar
  8. 8.
    Folprecht G, Cunningham D, Ross P et al (2004) Efficacy of 5-fluorouracil-based chemotherapy in elderly patients with metastatic colorectal cancer: a pooled analysis of clinical trials. Ann Oncol 15:1330–1338CrossRefPubMedGoogle Scholar
  9. 9.
    Grailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P, Faiz O (2013) Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc 27:19–30CrossRefPubMedGoogle Scholar
  10. 10.
    Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRefPubMedGoogle Scholar
  12. 12.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions Version 5.1.0. The Cochrane Collaboration, Available from www.cochrane-handbook.org
  14. 14.
    Stewart BT, Stitz RW, Lumley JW (1999) Laparoscopically assisted colorectal surgery in the elderly. Br J Surg 86:938–941CrossRefPubMedGoogle Scholar
  15. 15.
    Vignali A, Di Palo S, Tamburini A, Radaelli G, Orsenigo E, Staudacher C (2005) Laparoscopic versus open colectomies in octogenarians: a case-matched control study. Dis Colon Rectum 48:2070–2075CrossRefPubMedGoogle Scholar
  16. 16.
    Kurian AA, Suryadevara S, Vaughn D et al (2010) Laparoscopic colectomy in octogenarians and nonagenarians: a preferable option to open surgery? J Surg Educ 67:161–166CrossRefPubMedGoogle Scholar
  17. 17.
    Lian L, Kalady M, Geisler D, Kiran RP (2010) Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians. Surg Endosc 24:2039–2043CrossRefPubMedGoogle Scholar
  18. 18.
    Issa N, Grassi C, Melki Y, Powsner E, Dreznik Z (2011) Laparoscopic colectomy for carcinoma of the colon in octogenarians. J Gastrointest Surg 15:2011–2015CrossRefPubMedGoogle Scholar
  19. 19.
    Pinto RA, Ruiz D, Edden Y, Weiss EG, Nogueras JJ, Wexner SD (2011) How reliable is laparoscopic colorectal surgery compared with laparotomy for octogenarians? Surg Endosc 25:2692–2698CrossRefPubMedGoogle Scholar
  20. 20.
    Hinoi T, Kawaguchi Y, Hattori M et al (2014) Laparoscopic versus open surgery for colorectal cancer in elderly patients: a multicenter matched case–control study. Ann Surg Oncol 22:2040–2050CrossRefPubMedGoogle Scholar
  21. 21.
    Vallribera VF, Landi F, Espin BE et al (2014) Laparoscopy-assisted versus open colectomy for treatment of colon cancer in the elderly: morbidity and mortality outcomes in 545 patients. Surg Endosc 28:3373–3378CrossRefGoogle Scholar
  22. 22.
    Fielding LP, Phillips RK, Hittinger R (1989) Factors influencing mortality after curative resection for large bowel cancer in elderly patients. Lancet 1:595–597CrossRefPubMedGoogle Scholar
  23. 23.
    Brooks-Brunn JA (1997) Predictors of postoperative pulmonary complications following abdominal surgery. Chest 111:564–571CrossRefPubMedGoogle Scholar
  24. 24.
    Fujita T, Sakurai K (1995) Multivariate analysis of risk factors for postoperative pneumonia. Am J Surg 169:304–307CrossRefPubMedGoogle Scholar
  25. 25.
    Garibaldi RA, Britt MR, Coleman ML, Reading JC, Pace NL (1981) Risk factors for postoperative pneumonia. Am J Med 70:677–680CrossRefPubMedGoogle Scholar
  26. 26.
    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
  27. 27.
    Zollinger A, Krayer S, Singer T et al (1997) Haemodynamic effects of pneumoperitoneum in elderly patients with an increased cardiac risk. Eur J Anaesthesiol 14:266–275CrossRefPubMedGoogle Scholar
  28. 28.
    Song SP, Lian L, He XS, Wu XJ (2012) Laparoscopic colorectomy versus open colorectomy for elderly patients over 80 years old: a meta-analysis of safety and efficacy. Zhonghua Wei Chang Wai Ke Za Zhi 15:1027–1031PubMedGoogle Scholar
  29. 29.
    Zhu Q, Mao Z, Jin J, Deng Y, Zheng M, Yu B (2010) The safety of CO2 pneumoperitoneum for elderly patients during laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 20:54–57CrossRefPubMedGoogle Scholar
  30. 30.
    Hida K, Yamaguchi T, Hata H et al (2009) Risk factors for complications after laparoscopic surgery in colorectal cancer patients: experience of 401 cases at a single institution. World J Surg 33:1733–1740CrossRefPubMedGoogle Scholar
  31. 31.
    Gill TM, Allore HG, Gahbauer EA, Murphy TE (2010) Change in disability after hospitalization or restricted activity in older persons. JAMA 304:1919–1928PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Lamont CT, Sampson S, Matthias R, Kane R (1983) The outcome of hospitalization for acute illness in the elderly. J Am Geriatr Soc 31:282–288CrossRefPubMedGoogle Scholar
  33. 33.
    Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645CrossRefPubMedGoogle Scholar
  34. 34.
    Sheridan J, Walsh P, Kevans D et al (2014) Determinants of short- and long-term survival from colorectal cancer in very elderly patients. J Geriatr Oncol 5:376–383CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia Srl 2016

Authors and Affiliations

  • Y. Li
    • 1
    Email author
  • S. Wang
    • 2
  • S. Gao
    • 1
  • C. Yang
    • 2
  • W. Yang
    • 3
  • S. Guo
    • 4
  1. 1.Department of Colorectal SurgeryThe Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and InstituteTaiyuanChina
  2. 2.The Affiliated Cancer Hospital of Shanxi Medical UniversityShanxi Medical UniversityTaiyuanChina
  3. 3.Department of GastroenterologyThe Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and InstituteTaiyuanChina
  4. 4.Department of Molecular BiologyThe Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and InstituteTaiyuanChina

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