Skip to main content
SpringerLink
Log in

Laparoscopy in the Elderly Patient

  • Chapter
  • First Online:
Minimally Invasive Approaches to Colon and Rectal Disease

  • 5565 Accesses

Abstract

The surgical approach to elderly patients has undergone a major shift over the last two decades with the advent and widespread acceptance of a minimally invasive approach. The indications for laparoscopy in the elderly have shifted from a contraindication to a primary indication based on data and experience. The assessment of the elderly patient is based on physiologic age rather than chronologic age, but initial assessment is still critical in determining fitness for surgery. Ultimately, this is based primarily on known comorbidities and functional assessment. Laparoscopy in the elderly has been increasing over time, and data has been accrued that details the same advantages of an enhanced recovery protocol afforded in younger patients are also seen when using the laparoscopic approach in the elderly. Pneumoperitoneum induces multiple physiologic and hemodynamic changes, the sequelae of which may be accentuated in the elderly with increasing comorbid conditions.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 149.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007;50(17):1707–32.

    Article  PubMed  Google Scholar 

  2. American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery), American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg. 2008;106(3):685–712.

    Google Scholar 

  3. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol. 2009;54(22):e13–118.

    Google Scholar 

  4. Taylor EF, Thomas JD, Whitehouse LE, Quirke P, Jayne D, Finan PJ, et al. Population-based study of laparoscopic colorectal cancer surgery 2006–2008. Br J Surg. 2013;100(4):553–60.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Peters WR, Fleshman JW. Minimally invasive colectomy in elderly patients. Surg Laparosc Endosc. 1995;5(6):477–9.

    CAS  PubMed  Google Scholar 

  6. Reissman P, Agachan F, Wexner SD. Outcome of laparoscopic colorectal surgery in older patients. Am Surg. 1996;62(12):1060–3.

    CAS  PubMed  Google Scholar 

  7. Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, et al. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg. 2012;204(6):952–7.

    Article  PubMed  Google Scholar 

  8. 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(6):923–9.

    Article  CAS  PubMed  Google Scholar 

  9. 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(2):255–60.

    Article  PubMed  Google Scholar 

  10. Roscio F, Bertoglio C, De Luca A, Frigerio A, Galli F, Scandroglio I. Outcomes of laparoscopic surgery for colorectal cancer in elderly patients. JSLS. 2011;15(3):315–21.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Akiyoshi T, Kuroyanagi H, Fujimoto Y, Konishi T, Ueno M, Oya M, et al. Short-term outcomes of laparoscopic colectomy for transverse colon cancer. J Gastrointest Surg. 2010;14(5):818–23.

    Article  PubMed  Google Scholar 

  12. 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(3):326–32.

    Article  CAS  PubMed  Google Scholar 

  13. Stewart BT, Stitz RW, Lumley JW. Laparoscopically assisted colorectal surgery in the elderly. Br J Surg. 1999;86(7):938–41.

    Article  CAS  PubMed  Google Scholar 

  14. Law WL, Chu KW, Tung PH. Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg. 2002;195(6):768–73.

    Article  PubMed  Google Scholar 

  15. 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(11):2070–5.

    Article  PubMed  Google Scholar 

  16. Feng B, Zheng MH, Mao ZH, Li JW, Lu AG, Wang ML, et al. Clinical advantages of laparoscopic colorectal cancer surgery in the elderly. Aging Clin Exp Res. 2006;18(3):191–5.

    Article  PubMed  Google Scholar 

  17. 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(3):296–300.

    Article  PubMed  Google Scholar 

  18. 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(8):2039–43.

    Article  PubMed  Google Scholar 

  19. Kirchhoff P, Dincler S, Buchmann P. A multivariate analysis of potential risk factors for intra- and postoperative complications in 1316 elective laparoscopic colorectal procedures. Ann Surg. 2008;248(2):259–65.

    Article  PubMed  Google Scholar 

  20. Fiscon V, Portale G, Frigo F, Migliorini G. Laparoscopic resection of colorectal cancer: matched comparison in elderly and younger patients. Tech Coloproctol. 2010;14(4):323–7.

    Article  CAS  PubMed  Google Scholar 

  21. Rogers JP, Dobradin A, Kar PM, Alam SE. Overnight hospital stay after colon surgery for adenocarcinoma. JSLS. 2012;16(2):333–6.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP. Advantages of laparoscopic colectomy in older patients. Arch Surg. 2003;138(3):252–6.

    Article  PubMed  Google Scholar 

  23. Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X. Effectiveness of fast-track rehabilitation vs. conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis. 2012;14(8):1009–13.

    Article  CAS  PubMed  Google Scholar 

  24. Pawa N, Cathcart PL, Arulampalam TH, Tutton MG, Motson RW. Enhanced recovery program following colorectal resection in the elderly patient. World J Surg. 2012;36(2):415–23.

    Article  PubMed  Google Scholar 

  25. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050–9.

    Article  Google Scholar 

  26. Cheung HY, Chung CC, Fung JT, Wong JC, Yau KK, Li MK. Laparoscopic resection for colorectal cancer in octogenarians: results in a decade. Dis Colon Rectum. 2007;50(11):1905–10.

    Article  PubMed  Google Scholar 

  27. Grabowski JE, Talamini MA. Physiological effects of pneumoperitoneum. J Gastrointest Surg. 2009;13(5):1009–16.

    Article  PubMed  Google Scholar 

  28. Brown DR, Fishburne JI, Roberson VO, Hulka JF. Ventilatory and blood gas changes during laparoscopy with local anesthesia. Am J Obstet Gynecol. 1976;124(7):741–5.

    CAS  PubMed  Google Scholar 

  29. Safran DB, Orlando III R. Physiologic effects of pneumoperitoneum. Am J Surg. 1994;167(2):281–6.

    Article  CAS  PubMed  Google Scholar 

  30. Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg. 2004;21(2):95–105.

    Article  CAS  PubMed  Google Scholar 

  31. Diamant M, Benumof JL, Saidman LJ. Hemodynamics of increased intra-abdominal pressure: interaction with hypovolemia and halothane anesthesia. Anesthesiology. 1978;48(1):23–7.

    Article  CAS  PubMed  Google Scholar 

  32. Kashtan J, Green JF, Parsons EQ, Holcroft JW. Hemodynamic effect of increased abdominal pressure. J Surg Res. 1981;30(3):249–55.

    Article  CAS  PubMed  Google Scholar 

  33. Dexter SP, Vucevic M, Gibson J, McMahon MJ. Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy. Surg Endosc. 1999;13(4):376–81.

    Article  CAS  PubMed  Google Scholar 

  34. Chiu AW, Azadzoi KM, Hatzichristou DG, Siroky MB, Krane RJ, Babayan RK. Effects of intra-abdominal pressure on renal tissue perfusion during laparoscopy. J Endourol. 1994;8(2):99–103.

    Article  CAS  PubMed  Google Scholar 

  35. Shuto K, Kitano S, Yoshida T, Bandoh T, Mitarai Y, Kobayashi M. Hemodynamic and arterial blood gas changes during carbon dioxide and helium pneumoperitoneum in pigs. Surg Endosc. 1995;9(11):1173–8.

    CAS  PubMed  Google Scholar 

  36. Vittimberga Jr FJ, Foley DP, Meyers WC, Callery MP. Laparoscopic surgery and the systemic immune response. Ann Surg. 1998;227(3):326–34.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Ure BM, Niewold TA, Bax NM, Ham M, van der Zee DC, Essen GJ. Peritoneal, systemic, and distant organ inflammatory responses are reduced by a laparoscopic approach and carbon dioxide versus air. Surg Endosc. 2002;16(5):836–42.

    Article  CAS  PubMed  Google Scholar 

  38. West MA, Hackam DJ, Baker J, Rodriguez JL, Bellingham J, Rotstein OD. Mechanism of decreased in vitro murine macrophage cytokine release after exposure to carbon dioxide: relevance to laparoscopic surgery. Ann Surg. 1997;226(2):179–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Delgado S, Lacy AM, García Valdecasas JC, Balagué C, Pera M, Salvador L, Momblan D, Visa J. Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc. 2000;14(1):22–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Pennsylvania Hospital, University of Pennsylvania, 800 Walnut St. 20th Floor, Philadelphia, PA, 19106, USA

    Joshua I. S. Bleier M.D., F.A.C.S., F.A.S.C.R.S.

  2. Division of Colon and Rectal Surgery, Pennsylvania Hospital, University of Pennsylvania, 51 N. 39th St Suite W-266, Philadelphia, PA, 19104, USA

    Brian R. Kann M.D., F.A.C.S., F.A.S.C.R.S.

Authors
  1. Joshua I. S. Bleier M.D., F.A.C.S., F.A.S.C.R.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian R. Kann M.D., F.A.C.S., F.A.S.C.R.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua I. S. Bleier M.D., F.A.C.S., F.A.S.C.R.S. .

Editor information

Editors and Affiliations

  1. Division of Colon and Rectal Surgery Department of Surgery, Temple University Health System, Philadelphia, Pennsylvania, USA

    Howard M. Ross MD FACS FASCRS

  2. Division of Colon and Rectal Surgery, Department of Surgery, Weill-Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA

    Sang W. Lee MD, FACS, FASCRS

  3. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

    Matthew G. Mutch MD, FACS, FASCRS

  4. North Shore-LIJ Health System, Huntington Hospital, Hofstra University School of Medicine, Huntington, New York, USA

    David E. Rivadeneira MD, MBA,FACS, FASCRS

  5. Department of Colon & Rectal Surgery, Madigan Army Medical Center, Olympia, Washington, USA

    Scott R. Steele M.D., FACS, FASCRS

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Bleier, J.I.S., Kann, B.R. (2015). Laparoscopy in the Elderly Patient. In: Ross MD FACS FASCRS, H., Lee MD, FACS, FASCRS, S., Mutch MD, FACS, FASCRS, M., Rivadeneira MD, MBA,FACS, FASCRS, D., Steele M.D., FACS, FASCRS, S. (eds) Minimally Invasive Approaches to Colon and Rectal Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1581-1_28

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1581-1_28

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1580-4

  • Online ISBN: 978-1-4939-1581-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation