Skip to main content

Advertisement

SpringerLink
Log in

Long-term results after elective laparoscopic surgery for colorectal cancer in octogenarians

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to investigate the short- and long-term outcomes after elective laparoscopic surgery (LPS) for colorectal cancer patients over 80 years of age.

Methods

This was a retrospective study of all patients of 80 and above, who underwent elective colorectal resection, between January 2007 and January 2016. Data were analysed from a prospectively collected cancer database and cross checked with patient records. Determinants of survival were analysed using log-rank test and Kaplan–Meier curves.

Results

We identified 293 patients; 110 underwent LPS. LPS had significantly better overall survival (p = 0.0065) and disease-free survival (DFS) (p = 0.006). The LPS group also had a shorter length of stay (LOS)—9 vs 11 days (p < 0.00001), 90-day mortality—5.5 vs 13.7% (p = 0.03) and required fewer blood transfusions 22.7 vs 40.4% (p = 0.002), when compared to open surgery (OPS). There was no difference in 30-day mortality 1.8 vs 4.9% (p = 0.22), anastomotic leakage 2.3 vs 6% (p = 0.20) or post-operative complication rates 44.5 vs 50.8% (p = 0.30).

Conclusions

LPS for patients in their 80s is characterised by better overall and DFS compared to open procedures and is associated with shorter post-operative LOS, and significantly lower 90-day mortality. Patients operated on laparoscopically also required fewer post-operative blood transfusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Zavoral M, Suchanek S, Zavada F, Dusek L, Muzik J, Seifert B, Fric P (2009) Colorectal cancer screening in Europe. World J Gastroenterol 15(47):5907–5915

    Article  Google Scholar 

  2. Spann SJ, Rozen P, Young GP, Levin B (2002) Colorectal cancer: how big is the problem, why prevent it, and how might it present? In: Rozen P, Young GP, Levin B, Spann SJ (eds) Colorectal cancer in clinical practice. Martin Dunitz Ltd, London, pp 1–18

    Google Scholar 

  3. Keller DS, Delaney CP, Hashemi L, Haas EM (2016) A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc 30(10):4220–4228

    Article  Google Scholar 

  4. Sujatha-Bhaskar S, Alizadeh RF, Inaba CS, Koh CY, Jafari MD, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2018) Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit? Surg Endosc 32(3):1280–1285

    Article  Google Scholar 

  5. Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20(3):CD003145

    Google Scholar 

  6. Ha GW, Lee MR, Kim JH (2016) Adhesive small bowel obstruction after laparoscopic and open colorectal surgery: a systematic review and meta-analysis. Am J Surg 212(3):527–536

    Article  Google Scholar 

  7. Lee MG, Chiu CC, Wang CC, Chang CN, Lee SH, Lee M, Hsu TC, Lee CC (2017) Trends and outcomes of surgical treatment for colorectal cancer between 2004 and 2012—an analysis using National Inpatient Database. Sci Rep 7(1):2006

    Article  Google Scholar 

  8. Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N (2014) Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching. JAMA Surg 149(2):177–184

    Article  Google Scholar 

  9. Mäkelä JT, Klintrup KH, Rautio TT (2017) Mortality and survival after surgical treatment of colorectal cancer in patients aged over 80 years. Gastrointest Tumors 4(1–2):36–44

    Article  Google Scholar 

  10. Trastulli S, Cirocchi R, Listorti C, Cavaliere D, Avenia N, Gullà N, Giustozzi G, Sciannameo F, Noya G, Boselli C (2012) Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis 14(6):e277–e296

    Article  CAS  Google Scholar 

  11. 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 25:2692–2698

    Article  Google Scholar 

  12. Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T, Breukink S (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005200.pub3

    Article  PubMed  Google Scholar 

  13. Fernandez E, STROBE group (2005) Observational studies in epidemiology (STROBE). Med Clin (Barc) 125:43–48

    Article  Google Scholar 

  14. 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

    Article  Google Scholar 

  15. 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

    Article  Google Scholar 

  16. Lacy AM, Garcia-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

    Article  Google Scholar 

  17. 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(1):44–52

    Article  Google Scholar 

  18. Hinoi T, Kawaguchi Y, Hattori M, Okajima M, Ohdan H, Yamamoto S, Hasegawa H, Horie H, Murata K, Yamaguchi S, Sugihara K, Watanabe M (2015) Laparoscopic versus open surgery for colorectal cancer in elderly patients: a multicenter matched case-control study. Ann Surg Oncol 22(6):2040–2050

    Article  Google Scholar 

  19. Amato AC, Pescatori M (1998) Effect of perioperative blood transfusions on recurrence of colorectal cancer: meta-analysis stratified on risk factors. Dis Colon Rectum 41(5):570–585

    Article  CAS  Google Scholar 

  20. Burrows L, Tartter P (1982) Effect of blood transfusions on colonic malignancy recurrence rate. Lancet 2(8299):662

    Article  CAS  Google Scholar 

  21. Blumberg N, Agarwal MM, Chuang C (1985) Relation between recurrence of cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 290(6474):1037–1039

    Article  CAS  Google Scholar 

  22. Edna TH, Bjerkeset T (1998) Perioperative blood transfusions reduce long-term survival following surgery for colorectal cancer. Dis Colon Rectum 41(4):451–459

    Article  CAS  Google Scholar 

  23. Tartter PI (1988) Blood transfusion and infectious complications following colorectal cancer surgery. Br J Surg 75(8):789–792

    Article  CAS  Google Scholar 

  24. Byrne BE, Mamidanna R, Vincent CA, Faiz O (2013) Population-based cohort study comparing 30- and 90-day institutional mortality rates after colorectal surgery. Br J Surg 100(13):1810–1817

    Article  CAS  Google Scholar 

  25. National Bowel Cancer Audit. Performance indicators description. http://www.nboca.org.uk. Accessed 9 Jun 2018

  26. Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND (2004) Stress response to laparoscopic surgery: a review. Surg Endosc 18(7):1022–1028

    Article  CAS  Google Scholar 

  27. Wang F, Yu Z, Zhao M, Maomin S (2017) Long term outcomes of laparoscopic vs. open surgery for colorectal cancer in eldery patients: a meta-analysis. Mol Clin Oncol 7:771–776

    Article  Google Scholar 

  28. Odermatt M, Miskovic D, Flashman K, Khan J, Senapati A, O’Leary D, Thompson M, Parvaiz A (2015) Major postoperative complications following elective resection for colorectal cancer decrease long-term survival but not the time to recurrence. Colorectal Dis 17(2):141–149

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Colorectal Department, University Hospital Plymouth NHS Trust, Plymouth, UK

    Benjamin W. P. Rossi, Peter Labib, Elizabeth Ewers, Samantha Leong, Mark Coleman & Sebastian Smolarek

  2. Derriford Hospital, PL6 8DH, Plymouth, UK

    Benjamin W. P. Rossi

Authors
  1. Benjamin W. P. Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Labib
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Ewers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Samantha Leong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark Coleman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sebastian Smolarek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin W. P. Rossi.

Ethics declarations

Disclosures

Benjamin Rossi, Peter Labib, Elizabeth Ewers, Samantha Leong, Mark Coleman, and Sebastian Smolarek have no conflicts of interest or financial ties to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rossi, B.W.P., Labib, P., Ewers, E. et al. Long-term results after elective laparoscopic surgery for colorectal cancer in octogenarians. Surg Endosc 34, 170–176 (2020). https://doi.org/10.1007/s00464-019-06747-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06747-5

Keywords

Search

Navigation