Abstract
Background
To evaluate the effectiveness of laparoscopic surgery (LCS) for colon and rectal cancer in the very elderly over 80 years old.
Methods
We performed a prospective multicentric analysis comparing patients over 80 years (Group A) and patients between 60 and 69 years (Group B) undergoing LCS for cancer from January 2008 to December 2013. Colon and rectal cancers were analyzed separately. Comorbidity and complications were classified using the Charlson comorbidity index (CCI) and the Clavien–Dindo system, respectively. Oncological parameters included tumor-free margins, number of lymph nodes harvested and circumferential resection margin.
Results
Group A included 96 and 33 patients, and Group B 220 and 82 for colon and rectal cancers, respectively. Groups were similar except for ASA score and CCI, as expected. There was no significant difference in operative time [colon; rectum] (180[IQR 150–200] vs 180[150–210] min; NS—180[160–210] vs 180[165–240] min; NS), estimated blood loss (50[25–75] vs 50[25–120] mL; NS—50[0–150] vs 50[25–108.7] mL; NS) and conversion rate (2.1 vs 2.7 %; NS—3.0 vs 2.4 %; NS). Timing of first stool (3[2–3.25] vs 3[2–5] dd; NS—3[2–4] vs 3[2–5] dd; NS), length of stay (7[6–8] vs 7[6–8] dd; NS—8[8–9] vs 8[7–9] dd; NS) and readmission rate (1.0 vs 0.45 %; NS—6.1 vs 1.2 %; NS) were similar. Tumor-free margins were appropriate, and positivity of CRM is poor (6.1 vs 4.9; NS). We did not record significant differences in complications rate (47.9 vs 43.6 %; NS—63.6 vs 52.4 %; NS).
Conclusions
Laparoscopic surgery is effective for the treatment of colorectal cancer even in the very elderly. Age is not a risk factor or a limitation for LCS.
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References
Colorectal Cancer Collaborative Group (2000) Surgery for colorectal cancer in elderly patients: a systematic review. Lancet 356:968–974
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1(3):144–150
Schwenk W, Haase O, Neudecker JJ, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 3:CD003145
Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2:CD003432
Breukink S, Pieride JP, Wiggers T (2006) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4:CD005200
Zerey M, Hawver LM, AwadZ Stefanidis D, Richardson W, Fanelli RD, Members of the SAGES Guidelines Committee (2013) Guidelines for laparoscopic resection of curable colon and rectal cancer. Surg Endosc 27:1–10
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
PROCARE: multidisciplinary Belgian PROject on CAncer of the Rectum. Multidisciplinary guidelines for the treatment of rectal cancer can be downloaded from www.kankerregister.be or www.registreducancer.be
World Medical Association (WMA) Declaration of Helsinki—ethical principles for medical research involving human subjects. http://www.wma.net/en/30publications/10policies/b3/index.html. Accessed 22 Feb 2014
World Health Organization—Globocan (2012) Estimated incidence, mortality and prevalence worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx
Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (2015) SEER Cancer Stat Rev 1975–2011. National Cancer Institute, Bethesda, MD. http://seer.cancer.gov/csr/1975_2011/. Updated December 17, 2014
http://www.demo.istat.it/altridati/indicatori/2011/Tab_5.pdf
Masoomi H, Kang CY, Chen A, Mills S, Dolich MO, Carmichael JC, Stamos MJ (2012) Predictive factors of in-hospital mortality in colon and rectal surgery. J Am Coll Surg 215:255–261
Tan KJ, Kawamura YJ, Tokomitsu A, Tang T (2012) Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg 204:139–143
Diamantini G, Rossi P, Caciolo F, Levi Sandri GB, Procacciante F (2015) Colorectal surgery for cancer in very elderly patient. Int J Colorectal Dis. doi:10.1007/s00384-014-2106-5
Hiki N, Shimizu N, Yamaguchi H, Imamura K, Kami K, Kubota K, Kaminishi M (2006) Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg 93:195–204
Veenhof AA, Vlug MS, Van der Pas MH, Sietses C, Van der Peet DL, de Lange-de Klerk ES, Bonjer HJ, Bemelman WA, Cuesta MA (2012) Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg 255:216–221
Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H, Clinical Outcomes of Surgical Therapy Study Group (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662
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 97:1638–1645
Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52
Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7
Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774
Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL, European Association of Endoscopic Surgery (EAES) (2004) Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 18:1163–1185
Schiphorst AH, Pronk A, Borel Rinkes IH, Hamaker ME (2014) Representation of the elderly in trials of laparoscopic surgery for colorectal cancer. Colorectal Dis 16:976–983
Hamaker ME, Schiphorst AH, Verweij NM, Pronk A (2014) Improved survival for older patients undergoing surgery for colorectal cancer between 2008 and 2011. Int J Colorectal Dis 29:1231–1236
Miyasaka Y, Mochidome N, Kobayashi K, Ryu S, Akashi Y, Miyoshi A (2014) Efficacy of laparoscopic resection in elderly patients with colorectal cancer. Surg Today 44:1834–1840
Hatakeyama T, Nakanishi M, Murayama Y, Komatsu S, Shiozaki A, Kuriu Y, Ikoma H, Ichikawa D, Fujiwara H, Okamoto K, Ochiai T, Kokuba Y, Otsuji E (2013) Laparoscopic resection for colorectal cancer improves short-term outcomes in very elderly colorectal cancer patients. Surg Laparosc Endosc Percutan Tech 23:532–535
Schwandner O, Schiedeck THK, Bruch HP (1999) Advanced age—indication or contraindication for laparoscopic colorectal surgery? Dis Colon Rectum 42:356–362
Reissman P, Agachan F, Wexner SD (1996) Outcome of laparoscopic colorectal surgery in older patients. Am Surg 62:1060–1063
Yamamoto S, Watanabe M, Hasegawa H, Baba H, Kitajima M (2003) Short-term surgical outcomes of laparoscopic colonic surgery in octogenarians. A matched case–control study. Surg Laparosc Endosc Percutan Tech 13:95–100
Chautard J, Alves A, Zalinski S, Bretagnol F, Valleur P, Panis Y (2008) Laparoscopic colorectal surgery in elderly patients: a matched case–control study in 178 patients. J Am Coll Surg 206:255–260
Keller DS, Lawrance JK, Nobel T, Delaney CP (2013) Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery. Surg Endosc 27:4463–4468
Jeong DH, Hur H, Soh Min B, Baik SH, Kim NK (2013) Safety and feasibility of a laparoscopic colorectal cancer resection in elderly patients. Ann Coloproctol 29:22–27
Stewart BT, Stitz RW, Lumley JW (1999) Laparoscopically assisted colorectal surgery in the elderly. Br J Surg 86:938–941
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 24:2039–2043
Mukai T, Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T, Ikeda A, Yamaguchi T (2014) Outcomes of laparoscopic surgery for colorectal cancer in oldest-old patients. Surg Laparosc Endosc Percutan Tech 24:366–369
Nakamura T, Sato T, Miura H, Ikeda A, Tsutsui A, Naito M, Ogura N, Watanabe M (2014) Feasibility and outcomes of surgical therapy in very elderly patients with colorectal cancer. Surg Laparosc Endosc Percutan Tech 24:85–88
Heald RJ, Moran BJ, Ryall RDH, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899
Leonard D, Penninckx F, Fieuws S, Jouret-Mourin A, Sempoux C, Jehaes C, Van Eycken E, PROCARE, a Multidisciplinary Belgian Project on Cancer of the Rectum (2010) Factors predicting the quality of total mesorectal excision for rectal cancer. Ann Surg 252:982–988
Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH, Pathology Review Committee, Cooperative Clinical Investigators (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26:350–357
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 (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC Trial Group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726
Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484
Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229
Tan KY, Konishi F, Kawamura YJ, Maeda T, Sasaki J, Tsujinaka S, Horie H (2011) Laparoscopic corectal surgery in elderly patients: a case-control study of 15 years of experience. Am J Surg 20:531–536
Roscio F, Bertoglio C, De Luca A, Frigerio A, Galli F, Scandroglio I (2011) Outcomes of laparoscopic surgery for colorectal cancer in elderly patients. JSLS 15:315–321
Delgado S, Lacy AM, García-Valdecasas JC, Balaqué C, Pera M, Salvador L, Monblan D, Visa J (2000) Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc 14:22–26
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 43:326–332
Law WL, Chu KW, Tung P (2002) Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg 195:768–773
Senagore A, Madbouly K, Fazio V, Duepree H, Brady K, Delaney C (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138:252–256
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 17:923–929
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 48:2070–2075
Feng B, Zheng MH, Mao ZH, Li JW, Lu AG, Wang ML, Hu WG, Dong F, Hu YY, Zang L, Li HW (2006) Clinical advantages of laparoscopic colorectal cancer surgery in the elderly. Aging Clin Exp Res 18:191–195
She WH, Poon JTC, Fan JKM, Lo OSH, Law WL (2013) Outcome of laparoscopic colectomy for cancer in elderly patients. Surg Endosc 27:308–312
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Francesco Roscio, Luigi Boni, Federico Clerici, Paolo Frattini, Elisa Cassinotti and Ildo Scandroglio have no conflicts of interest or financial ties to disclose.
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Roscio, F., Boni, L., Clerici, F. et al. Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case–control assessment. Surg Endosc 30, 4372–4382 (2016). https://doi.org/10.1007/s00464-016-4755-7
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DOI: https://doi.org/10.1007/s00464-016-4755-7