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Long-term results of a randomized study comparing open surgery and laparoscopic surgery in elderly colorectal cancer patients (Eld Lap study)

Surgical Endoscopy volume 35, pages 5686–5697 (2021)Cite this article

Abstract

Background

We reported favorable short-term results of laparoscopic surgery in a randomized study comparing open and laparoscopic surgery for elderly patients with colorectal cancer (CRC). The purpose of this study is to clarify the long-term outcomes of the laparoscopic surgery for elderly patients with CRC.

Methods

The inclusion criteria were ≥ 75 years, adenocarcinoma, ≤ T4a, M0 and elective surgery. The patients were randomly allocated to open or laparoscopic surgery according to the tumor location. The survival rates, recurrence and reasons for death were compared.

Result

One hundred patients (right colon 43, left colon 28, rectum 29) were included in each group. Eight patients who underwent open surgery and 2 patients who underwent laparoscopic surgery were excluded from the analysis because of metastatic diseases and other malignancies found during the operations. One hundred ninety patients (98 open, 98 laparoscopic) were analyzed. There was no difference in the backgrounds excluding more patients with vascular invasion in the laparoscopic rectal cancer. There were no differences in the 5-year overall survival rate (open vs. laparoscopic; 78.9% vs. 82.1%, p = 0.638), 5-year disease-free survival rate (70.5% vs. 62.8%, p = 0.276), 5-year recurrence-free survival rate (76.1% vs. 72.1%, p = 0.419), or 5-year cancer-specific survival rate (86.1% vs. 80.5%, p = 0.208). No differences in survival were detected in the analyses of stage and tumor location. There was no significant difference in the overall recurrence rate or recurrence site. However, distant lymph node metastases and local recurrences were more common after laparoscopic surgery than after open surgery. There was no difference in the cause of death. More than half of the patients died from other diseases in both groups (57.9% vs. 52.6%, p = 0.765).

Conclusion

Laparoscopic surgery showed similar long-term results compared to open surgery in elderly patients with CRC. Laparoscopic surgery is an effective surgical procedure for elderly patients with CRC.

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Author information

Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan

    Shoichi Fujii, Shigeru Yamagishi, Jun Watanabe, Yusuke Suwa & Chikara Kunisaki

  2. Department of Surgery, Koga Community Hospital, 2-30-1 Daikakuji, Yaizu, Shizuoka, 425-0088, Japan

    Shoichi Fujii

  3. Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, 4-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Atsushi Ishibe, Mitsuyoshi Ota & Itaru Endo

Authors
  1. Shoichi Fujii
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  2. Atsushi Ishibe
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  3. Mitsuyoshi Ota
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  4. Shigeru Yamagishi
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  5. Jun Watanabe
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  7. Chikara Kunisaki
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  8. Itaru Endo
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Contributions

SF contributed to the study conception and designs. AI, MO, SY, JW, and YS contributed to data acquisition. SF contributed to the analysis of the data, interpretation of the outcomes, and writing the report. CK and IE contributed editing, reviewing, and final approval of the report.

Corresponding author

Correspondence to Shoichi Fujii.

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Disclosures

Shoichi Fujii, Atsushi Ishibe, Mitsuyoshi Ota, Shigeru Yamagishi, Jun Watanabe, Yusuke Suwa, Chikara Kunisaki, and Itaru Endo have no conflict of interest or financial ties to disclose.

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Fujii, S., Ishibe, A., Ota, M. et al. Long-term results of a randomized study comparing open surgery and laparoscopic surgery in elderly colorectal cancer patients (Eld Lap study). Surg Endosc 35, 5686–5697 (2021). https://doi.org/10.1007/s00464-020-08026-0

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Keywords

  • Laparoscopic surgery
  • Colorectal cancer
  • Elderly patient
  • Randomized controlled study
  • Long-term result