Abstract
Background
Elderly patients who undergo major abdominal surgery are potentially at a higher risk of perioperative mortality and postoperative complications. Although laparoscopic surgery has been widely accepted as a less invasive surgical procedure for colorectal diseases, the benefits for elderly patients have not been validated.
Aim
To compare postoperative outcomes and long-term survival between laparoscopic and open colorectal surgery in the elderly population.
Methods
A literature search was electronically performed to identify all studies comparing postoperative outcomes between laparoscopic and open colorectal resections in the elderly population. Primary outcomes were postoperative mortality and complications, and the secondary outcome was long-term survival.
Results
Overall, 30 studies (70,946 patients) met our inclusion criteria. Laparoscopic surgery was significantly associated with a decreased risk of perioperative mortality [odds ratio (OR), 0.55; 95 % confidence interval (CI), 0.45–0.68; P < 0.01] and postoperative complications (OR, 0.55; 95 % CI, 0.48–0.63; P < 0.01) compared with open surgery. There was no significant difference in long-term survival between the two procedures (OR, 0.89; 95 % CI, 0.72–1.07; P = 0.31).
Conclusions
Laparoscopic colorectal surgery in the elderly population has significant advantages in terms of short-term outcomes. Aggressive application of laparoscopic colorectal surgery should be considered for the elderly population.
Similar content being viewed by others
References
World Population Prospects: the 2012 revision [database online]. United Nations; 2014.
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.
Evers BM, Townsend CM, Jr., Thompson JC. Organ physiology of aging. Surg Clin North Am. 1994;74:23-39.
Story DA. Postoperative complications in elderly patients and their significance for long-term prognosis. Curr Opin Anaesthesiol. 2008;21:375-379.
Zucker KA, Pitcher DE, Martin DT, Ford RS. Laparoscopic-assisted colon resection. Surg Endosc. 1994;8:12-17; discussion 18.
Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM. Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study. Dis Colon Rectum. 2000;43:326-332.
Law WL, Chu KW, Tung PH. Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg. 2002;195:768-773.
Sklow B, Read T, Birnbaum E, Fry R, Fleshman J. Age and type of procedure influence the choice of patients for laparoscopic colectomy. Surg Endosc. 2003;17:923-929.
Vignali A, Di Palo S, Tamburini A, Radaelli G, Orsenigo E, Staudacher C. Laparoscopic vs. open colectomies in octogenarians: a case-matched control study. Dis Colon Rectum. 2005;48:2070-2075.
Lian L, Kalady M, Geisler D, Kiran RP. Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians. Surg Endosc. 2010;24:2039-2043.
Tan WS, Chew MH, Lim IA, Ng KH, Tang CL, Eu KW. Evaluation of laparoscopic versus open colorectal surgery in elderly patients more than 70 years old: an evaluation of 727 patients. Int J Colorectal Dis. 2012;27:773-780.
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.
Allardyce RA, Bagshaw PF, Frampton CM, et al. Australasian Laparoscopic Colon Cancer Study shows that elderly patients may benefit from lower postoperative complication rates following laparoscopic versus open resection. Br J Surg. 2010;97:86-91.
Russo A, Marana E, Viviani D, et al. Diastolic function: the influence of pneumoperitoneum and Trendelenburg positioning during laparoscopic hysterectomy. Eur J Anaesthesiol. 2009;26:923-927.
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;206:255-260.
Delgado S, Lacy AM, Garcia Valdecasas JC, et al. Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc. 2000;14:22-26.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603-605.
Castillo JJ, Dalia S, Pascual SK. Association between red blood cell transfusions and development of non-Hodgkin lymphoma: a meta-analysis of observational studies. Blood. 2010;116:2897-2907.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177-188.
Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8:16.
Fujii S, ishibe A, Ota M, et al. Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients. Surg Endosc. 2013; [Epub ahead of print].
Stewart BT, Stitz RW, Lumley JW. Laparoscopically assisted colorectal surgery in the elderly. Br J Surg. 1999;86:938-941.
Tuech JJ, Pessaux P, Rouge C, Regenet N, Bergamaschi R, Arnaud JP. Laparoscopic vs open colectomy for sigmoid diverticulitis: a prospective comparative study in the elderly. Surg Endosc. 2000;14:1031-1033.
She WH, Poon JTC, Fan JKM, Lo OSH, Law WL. Outcome of laparoscopic colectomy for cancer in elderly patients. Surgical Endoscopy and Other Interventional Techniques. 2013;27:308-312.
Cummings LC, Delaney CP, Cooper GS. Laparoscopic versus open colectomy for colon cancer in an older population: a cohort study. World Journal of Surgical Oncology. 2012;10.
White SI, Wright D, Taylor CJ. A comparison of laparoscopic versus open rectal surgery in 114 consecutive octogenarians. Colorectal Disease. 2012;14:E395-E399.
Altuntas YE, Gezen C, Vural S, Okkabaz N, Kement M, Oncel M. Laparoscopy for sigmoid colon and rectal cancers in septuagenarians: a retrospective, comparative study. Techniques in Coloproctology. 2012;16:213-219.
Issa N, Grassi C, Melki Y, Powsner E, Dreznik Z. Laparoscopic colectomy for carcinoma of the colon in octogenarians. Journal of Gastrointestinal Surgery. 2011;15:2011-2015.
Al-Refaie WB, Parsons HM, Habermann EB, et al. Operative outcomes beyond 30-day mortality: colorectal cancer surgery in oldest old. Ann Surg. 2011;253:947-952.
Pinto RA, Ruiz D, Edden Y, Weiss EG, Nogueras JJ, Wexner SD. How reliable is laparoscopic colorectal surgery compared with laparotomy for octogenarians? Surg Endosc. 2011;25:2692-2698.
Robinson CN, Balentine CJ, Marshall CL, et al. Minimally invasive surgery improves short-term outcomes in elderly colorectal cancer patients. Journal of Surgical Research. 2011;166:182-188.
Tomimaru Y, Ide Y, Murata K. Outcome of laparoscopic surgery for colon cancer in elderly patients. Asian J Endosc Surg. 2011;4:1-6.
Kennedy GD, Rajamanickam V, O'Connor ES, et al. Optimizing surgical care of colon cancer in the older adult population. Annals of Surgery. 2011;253:508-514.
Faiz O, Haji A, Botte A, Clark SK, Darzi AW, Aylin P. Elective colonic surgery for cancer in the elderly: an investigation into postoperative mortality in English NHS hospitals between 1996 and 2007. Colorectal Disease. 2011;13:779-789.
Tei M, Ikeda M, Haraguchi N, et al. Postoperative complications in elderly patients with colorectal cancer comparison of open and laparoscopic surgical procedures. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2009;19:488-492.
Akiyoshi T, Kuroyanagi H, Oya M, et al. Short-term outcomes of laparoscopic rectal surgery for primary rectal cancer in elderly patients: is it safe and beneficial? Journal of Gastrointestinal Surgery. 2009;13:1614-1618.
Person B, Cera SM, Sands DR, et al. Do elderly patients benefit from laparoscopic colorectal surgery? Surg Endosc. 2008;22:401-405.
Feng B, Zheng MH, Mao ZH, et al. Clinical advantages of laparoscopic colorectal cancer surgery in the elderly. Aging Clin Exp Res. 2006;18:191-195.
Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP. Advantages of laparoscopic colectomy in older patients. Arch Surg. 2003;138:252-256.
Miyasaka Y, Mochidome N, Kobayashi K, Ryu S, Akashi Y, Miyoshi A. Efficacy of laparoscopic resection in elderly patients with colorectal cancer. Surg Today. 2013;[Epub ahead of print].
Suto T, Sato T. Evaluation of laparoscopy-assisted surgery in elderly colorectal cancer patients. Nippon Ronen Igakkai Zasshi. 2011;48:655-671.
Green BL, Marshall HC, Collinson F, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100:75-82.
Colon Cancer Laparoscopic or Open Resection Study G, Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44-52.
Fleshman J, Sargent DJ, Green E, 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;246:655-662; discussion 662-654.
Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients. Surg Endosc. 2014.
Dhoste K, Lacoste L, Karayan J, Lehuede MS, Thomas D, Fusciardi J. Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patients. Can J Anaesth. 1996;43:783-788.
Harris SN, Ballantyne GH, Luther MA, Perrino AC, Jr. Alterations of cardiovascular performance during laparoscopic colectomy: a combined hemodynamic and echocardiographic analysis. Anesth Analg. 1996;83:482-487.
Gebhardt H, Bautz A, Ross M, Loose D, Wulf H, Schaube H. Pathophysiological and clinical aspects of the CO2 pneumoperitoneum (CO2-PP). Surg Endosc. 1997;11:864-867.
Yamamoto S, Watanabe M, Hasegawa H, Baba H, Kitajima M. Short-term surgical outcomes of laparoscopic colonic surgery in octogenarians: a matched case-control study. Surg Laparosc Endosc Percutan Tech. 2003;13:95-100.
Whelan RL, Franklin M, Holubar SD, et al. Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc. 2003;17:972-978.
Wichmann MW, Huttl TP, Winter H, et al. Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study. Arch Surg. 2005;140:692-697.
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.
Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group. Lancet. 2000;356:968-974.
Bo M, Cacello E, Ghiggia F, Corsinovi L, Bosco F. Predictive factors of clinical outcome in older surgical patients. Arch Gerontol Geriatr. 2007;44:215-224.
Ansaloni L, Catena F, Chattat R, et al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg. 2010;97:273-280.
Conflicts of Interest
None declared
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplement 1
Funnel plot of overall postopetrative complications (GIF 105 kb)
Supplement 2
Results of meta-regression analysis (GIF 17 kb)
Rights and permissions
About this article
Cite this article
Seishima, R., Okabayashi, K., Hasegawa, H. et al. Is laparoscopic Colorectal Surgery Beneficial for Elderly Patients? A Systematic Review and Meta-Analysis. J Gastrointest Surg 19, 756–765 (2015). https://doi.org/10.1007/s11605-015-2748-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-015-2748-9