Skip to main content

Efficacy of laparoscopic resection in elderly patients with colorectal cancer

Surgery Today volume 44, pages 1834–1840 (2014)Cite this article

Abstract

Purpose

The perioperative outcomes of laparoscopic colorectal surgery in elderly patients were compared with those of open surgery in elderly patients and those of laparoscopic surgery in nonelderly patients to evaluate the feasibility and efficacy of laparoscopic surgery in elderly patients with colorectal cancer.

Methods

The data of the patients who underwent surgical resection for colorectal cancer between January 2007 and September 2012 were retrospectively collected. The clinical backgrounds and outcomes of elderly patients (≥70 years of age) who underwent laparoscopic surgery (EL group) were compared with those of elderly patients who underwent open surgery (EO group) and those of nonelderly patients (<70 years of age) who underwent laparoscopic surgery (NL group).

Results

Compared with the EO group, the EL group showed significantly less blood loss (15 versus 100 ml), fewer postoperative complications (10.7 versus 36.7 %), earlier resumption of an oral diet (4 versus 5 days) and shorter postoperative hospital stays (16 versus 28 days). A case-matched analysis showed similar results. All perioperative outcomes were equivalent between the EL and NL groups.

Conclusions

Laparoscopic colorectal surgery in elderly patients with cancer was not only superior to open surgery in elderly patients, but also equivalent to laparoscopic surgery in nonelderly patients in terms of the postoperative outcomes.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Ministry of Internal Affairs and Communications Statistical Bureau, Director-General for Policy Planning (Statistical Standards) and Statistical Research and Training Institute. Population estimates by age (5-year age group) and sex. Ministry of Internal Affairs and Communications, Tokyo; 2012. http://www.stat.go.jp/english/data/jinsui/tsuki/index.htm (Accessed 13 Jan 2013).

  2. Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T. Cancer incidence and incidence rates in Japan in 2006: based on data from 15 population-based cancer registries in the monitoring of cancer incidence in Japan (MCIJ) project. Jpn J Clin Oncol. 2012;42:139–47.

    PubMed  Article  Google Scholar 

  3. Colorectal Cancer Collaborative Group. Surgery for colorectal cancer in elderly patients: a systematic review. Lancet. 2000;356:968–74.

    Article  Google Scholar 

  4. Masoomi H, Kang CY, Chen A, Mills S, Dolich MO, Carmichael JC, Stamos MJ. Predictive factors of in-hospital mortality in colon and rectal surgery. J Am Coll Surg. 2012;215:255–61.

    PubMed  Article  Google Scholar 

  5. Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg. 2004;91:1111–24.

    PubMed  Article  CAS  Google Scholar 

  6. Tjandra JJ, Chan MK. Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis. 2006;8:375–88.

    PubMed  Article  CAS  Google Scholar 

  7. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW, Jr., et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246:655–62 (discussion 662–4).

    Google Scholar 

  8. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, et al. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg. 2008;248:1–7.

    PubMed  Article  Google Scholar 

  9. Akiyoshi S, Mimori K, Sudo T, Tanaka F, Shibata K, Mori M. Laparoscopic surgery minimizes the surgical manipulation of isolated tumor cells leading to decreased metastasis compared to open surgery for colorectal cancer. Surg Today. 2013;43:20–5.

    PubMed  Article  Google Scholar 

  10. Massarweh NN, Legner VJ, Symons RG, McCormick WC, Flum DR. Impact of advancing age on abdominal surgical outcomes. Arch Surg. 2009;144:1108–14.

    PubMed  Article  Google Scholar 

  11. Duron JJ, Duron E, Dugue T, Pujol J, Muscari F, Collet D, et al. Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg. 2011;254:375–82.

    PubMed  Article  Google Scholar 

  12. She WH, Poon JT, Fan JK, Lo OS, Law WL. Outcome of laparoscopic colectomy for cancer in elderly patients. Surg Endosc. 2013;27:308–12.

    PubMed  Article  Google Scholar 

  13. Law WL, Chu KW, Tung PH. Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg. 2002;195:768–73.

    PubMed  Article  Google Scholar 

  14. Chautard J, Alves A, Zalinski S, Bretagnol F, Valleur P, Panis Y. Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients. J Am Coll Surg. 2008;206:255–60.

    PubMed  Article  Google Scholar 

  15. Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum. 2008;51:296–300.

    PubMed  Article  Google Scholar 

  16. Person B, Cera SM, Sands DR, Weiss EG, Vernava AM, Nogueras JJ, et al. Do elderly patients benefit from laparoscopic colorectal surgery? Surg Endosc. 2008;22:401–5.

    PubMed  Article  CAS  Google Scholar 

  17. Grailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P, Faiz O. Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc. 2013;27:19–30.

    PubMed  Article  Google Scholar 

  18. Poon JT, Law WL, Wong IW, Ching PT, Wong LM, Fan JK, et al. Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg. 2009;249:77–81.

    PubMed  Article  Google Scholar 

  19. Vamvakas EC. Possible mechanisms of allogeneic blood transfusion-associated postoperative infection. Transfus Med Rev. 2002;16:144–60.

    PubMed  Article  Google Scholar 

  20. Huang C, Huang R, Jiang T, Huang K, Cao J, Qiu Z. Laparoscopic and open resection for colorectal cancer: an evaluation of cellular immunity. BMC Gastroenterol. 2010;10:127.

    PubMed  Article  PubMed Central  Google Scholar 

  21. Whelan RL, Franklin M, Holubar SD, Donahue J, Fowler R, Munger C, et al. Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc. 2003;17:972–8.

    PubMed  Article  CAS  Google Scholar 

  22. Wichmann MW, Huttl TP, Winter H, Spelsberg F, Angele MK, Heiss MM, et al. Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study. Arch Surg. 2005;140:692–7.

    PubMed  Article  Google Scholar 

  23. Kim J, Mittal R, Konyalian V, King J, Stamos MJ, Kumar RR. Outcome analysis of patients undergoing colorectal resection for emergent and elective indications. Am Surg. 2007;73:991–3.

    PubMed  Google Scholar 

  24. Hida K, Hasegawa S, Kinjo Y, Yoshimura K, Inomata M, Ito M, et al. Open versus laparoscopic resection of primary tumor for incurable stage IV colorectal cancer: a large multicenter consecutive patients cohort study. Ann Surg. 2012;255:929–34.

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

Drs. Yoshihiro Miyasaka, Naoki Mochidome, Kiichiro Kobayashi, Shinichiro Ryu, Yoshio Akashi and Akira Miyoshi have no conflicts of interest to declare in association with this study.

Author information

Affiliations

  1. Department of Surgery, Chihaya Hospital, 2-30-1 Chihaya, Higashi-ku, Fukuoka, 813-8501, Japan

    Yoshihiro Miyasaka, Naoki Mochidome, Kiichiro Kobayashi, Shinichiro Ryu, Yoshio Akashi & Akira Miyoshi

Authors
  1. Yoshihiro Miyasaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoki Mochidome
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiichiro Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shinichiro Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshio Akashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akira Miyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshihiro Miyasaka.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Miyasaka, Y., Mochidome, N., Kobayashi, K. et al. Efficacy of laparoscopic resection in elderly patients with colorectal cancer. Surg Today 44, 1834–1840 (2014). https://doi.org/10.1007/s00595-013-0753-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0753-8

Keywords

  • Laparoscopic
  • Colorectal cancer
  • Elderly