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Advanced age—indication or contraindication for laparoscopic colorectal surgery?

  • Original Contributions
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Diseases of the Colon & Rectum

Abstract

PURPOSE: It has been proposed that laparoscopic colorectal surgery offers several benefits to patients. The aim of this study was to evaluate particularly whether older patients can benefit by laparoscopic colorectal procedures or if minimally invasive procedures are contraindicated. METHODS: All patients who underwent elective surgery were divided into age-related groups: patients 50 years of age or younger, patients ranging from 51 to 70 years of age, and patients older than 70 years. The groups by age were compared with each other relative to their cardiopulmonary status, indication, procedure, conversion, morbidity, mortality, duration of surgery, perioperative blood transfusion, stay on the intensive care unit, and hospitalization. Statistical analysis included univariate analysis by chi-squared tests and Student'st-tests comparing patients older than 70 years with patients 50 years of age or younger and with patients ranging from 51 to 70 years of age (statistical significance was defined asP<0.05). RESULTS: Within five years 298 patients (male/female ratio, 0.38) underwent a laparoscopic or laparoscopic-assisted colorectal procedure. Of these, 95 (31.9 percent) patients were older than 70 years, 138 (46.3 percent) patients ranged from 51 to 70 years of age, and 65 (21.8 percent) patients were 50 years of age or younger. Pathologic findings in cardiopulmonary function increased with age. There were no statistically significant differences among the younger, middle-aged, and older patients relative to the incidence of conversion (3.1vs. 9.4vs. 7.4 percent, respectively), major complications (4.6vs. 10.1vs. 9.5 percent, respectively), minor complications (12.3vs. 15.2vs. 12.6 percent, respectively) or total laparotomy rate (7.7vs. 12.3vs. 12.6 percent, respectively).P>0.05 for all comparisons. However, duration of surgery, stay on the intensive care unit, and postoperative hospitalization were significantly prolonged in patients older than 70 years (P<0.05 for all comparisons) but were reduced during the five years of experience with these procedures. CONCLUSIONS: If preoperative assessment of comorbid conditions and perioperative care was ensured, laparoscopic procedures were shown to be safe options in the elderly. The outcome of laparoscopic colorectal surgery in patients older than 70 years is similar to that noted in younger patients. Advanced age is no contraindication for laparoscopic colorectal surgery.

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Authors and Affiliations

  1. From the Department of Surgery, Medical University of Luebeck, Luebeck, Germany

    Oliver Schwandner M.D., Thomas H. K. Schiedeck M.D. & Hans-Peter Bruch M.D.

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  1. Oliver Schwandner M.D.
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  2. Thomas H. K. Schiedeck M.D.
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  3. Hans-Peter Bruch M.D.
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Schwandner, O., Schiedeck, T.H.K. & Bruch, HP. Advanced age—indication or contraindication for laparoscopic colorectal surgery?. Dis Colon Rectum 42, 356–362 (1999). https://doi.org/10.1007/BF02236353

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