Background and aims: Elderly patients have a high incidence of colorectal cancer, which may be associated with increased morbidity and mortality due to complex comorbidity and diminished cardiopulmonary reserves. The aims of this study were to compare the outcomes of laparoscopic colorectal cancer surgery with those observed in traditional open surgery in patients aged over 70 years. Methods: Between January 2003 and October 2004, 51 patients aged over 70 years with colorectal cancer, who underwent laparoscopic surgery (LAP group), were evaluated and compared with 102 controls (also over 70 years old) treated by traditional open surgery (OPEN group) in the same period. All patients were evaluated with respect to the American Society of Anesthesiologists (ASA) classification, surgery-related complications, and postoperative recovery. Results: No surgery-related death was observed in the LAP group, whereas two deaths occurred in the OPEN group for severe post-operative pulmonary infection and anastomotic leak, respectively. No pneumoperitoneum-related complications were observed in the LAP group; 2 (3.9%) patients required conversion to open surgery, because of the unexpectedly bulky tumor and severe adhesions in the abdominal cavity. With the increase in patients’ age, increased ASA classification was observed. No significant differences were observed in gender, Dukes’ staging or types of procedures between LAP and OPEN groups. The overall morbidity in the LAP group was significantly less than that of the OPEN group [17.6% (9/51) vs 37.3% (38/102), p=0.013]. Mean blood loss, time to flatus passage, and time to semi-liquid diet in the LAP group were significantly shorter than those of the OPEN group (90.7±49.9 vs 150.3±108.7ml, 2.4±1.2 vs 3.5±2.9 d, 5.0±1.8 vs 5.9±1.2 d, respectively, p<0.05). No significant differences were observed in terms of mean operation time or hospital stay between LAP and OPEN groups. Conclusion: Laparoscopic colorectal cancer surgery in elderly patients with colon cancer has clinically significant advantages over traditional open surgery, and appears to be the ideal surgical choice for the elderly.
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Barrier A, Ferro L, Houry S, Lacaine F, Huguier M. Rectal cancer surgery in patients more than 80 years of age. Am J Surg 2003; 185: 54–7.
Polanczyk CA, Marcantonio E, Goldman L, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 2001; 134: 637–43.
Bufalari A, Ferri M, Cao P, et al. Surgical care in octogenarians. Br J Surg 1996; 83: 1783–7.
Weber DM. Laparoscopic surgery: an excellent approach in elderly patients. Arch Surg 2003; 138: 1083–8.
Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy- assisted colectomy versus open colectomy for treatment of non- metastatic colon cancer: a randomised trial. Lancet 2002; 359: 2224–9.
Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350: 2050–9.
Scheidbach H, Schneider C, Hugel O, et al. Laparoscopic Col- orectal Surgery Study Group. Oncological quality and preliminary long-term results in laparoscopic colorectal surgery. Surg Endosc 2003; 17: 903–10.
Delgado S, Lacy AM, Garcia Valdecasas JC, et al. Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc 2000; 14: 22–6.
Monson K, Litvak DA, Bold RJ. Surgery in the aged population: surgical oncology. Arch Surg 2003; 138: 1061–7.
Schwandner O, Schiedeck TH, Bruch HP. Advanced age—indication or contraindication for laparoscopic colorectal surgery? Dis Colon Rectum 1999; 42: 356–62.
Stocchi L, Nelson H, Young-Fadok TM, et al. Safety and advantages of laparoscopic vs open colectomy in the elderly: matched-control study. Dis Colon Rectum 2000; 43: 326–32.
Zheng MH, Feng B, Lu AG, et al. Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol 2005; 11: 323–6.
MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993; 341: 457–60.
Shirouzu K, Ogata Y, Araki Y. Oncologic and functional results of total mesorectal excision and autonomic nerve-preserving operation for advanced lower rectal cancer. Dis Colon Rectum 2004; 47: 1442–7.
Shamburek RD, Farrar JT. Disorders of the digestive system in the elderly. N Engl J Med 1990; 322: 438–43.
Holt PR. Gastrointestinal diseases in the elderly. Curr Opin Clin Nutr Metab Care 2003; 6: 41–8.
Lewis AA, Khoury GA. Resection for colorectal cancer in the very old: are the risks too high? BMJ (Clin Res Ed) 1988; 296: 459–61.
Boyd JB, Bradford B Jr, Watne AL. Operative risk factors of colon resection in the elderly. Ann Surg 1980; 192: 743–6.
Organ CH Jr. Surgery in the aged. Arch Surg 2003; 138: 1046.
Stewart BT, Stitz RW, Lumley JW. Laparoscopically assisted colorectal surgery in the elderly. Br J Surg 1999; 86: 938–41.
Hashimoto S, Hashikura Y, Munakata Y, et al. Changes in the cardiovascular and respiratory systems during laparoscopic chole- cystectomy. J Laparoendosc Surg 1993; 3: 535–9.
Marathe US, Lilly RE, Silvestry SC, et al. Alterations in hemo- dynamics and left ventricular contractility during carbon dioxide pneumoperitoneum. Surg Endosc 1996; 10: 974–8.
Ho HS, Gunther RA, Wolfe BM. Intraperitoneal carbon dioxide insufflation and cardiopulmonary functions. Laparoscopic chole- cystectomy in pigs. Arch Surg 1992; 127: 928–32.
Portera CA, Compton RP, Walters DN, et al. Benefits of pulmonary artery catheter and transesophageal echocardiographic monitoring in laparoscopic cholecystectomy patients with cardiac disease. Am J Surg 1995; 169: 202–6.
Ballesta Lopez C, Cid JA, Poves I, et al. Laparoscopic surgery in the elderly patient. Surg Endosc 2003; 17: 333–7.
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Feng, B., Zheng, MH., Mao, ZH. et al. Clinical advantages of laparoscopic colorectal cancer surgery in the elderly. Aging Clin Exp Res 18, 191–195 (2006). https://doi.org/10.1007/BF03324648
- Colorectal neoplasms