Skip to main content
SpringerLink
Log in

Safety and advantages of laparoscopicvs. open colectomy in the elderly

Matched-control study

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: The aim of this study was to determine rates of complications and extent of benefits for laparoscopic-assisted colectomy compared with open colectomy in patients older than age 75. METHODS: Forty-two patients undergoing laparoscopic-assisted colectomy (1992–1998) were matched to 42 open colectomy patients for gender, age, year of surgery, operating surgeon, and procedure. Health status (American Society of Anesthesiology score), previous abdominal surgery, conversion rate, surgical outcome, and need for assistance at admission and dismissal (independencevs. home with assistancevs. nursing facilities) were reviewed. RESULTS: Mean ages were 81.2 and 80.5 years for laparoscopic-assisted colectomy and open colectomy, respectively (P=not significant). Twenty-one laparoscopic-assisted colectomy and 23 open colectomy patients were females. American Society of Anesthesiology scores were comparable, as were rates of previous abdominal surgery (57 percent for laparoscopic-assisted colectomyvs. 62 percent for open colectomy;P=not significant). Mean operative times were longer for laparoscopic-assisted colectomy (190 minutes for laparoscopic-assisted colectomyvs. 142 minutes for open colectomy;P<0.001); operating room times progressively decreased from 221 minutes in 1992 to 1995 to 147 in 1998 for laparoscopic right hemicolectomy (P<0.001). The conversion rate for laparoscopic-assisted colectomy was 14.3 percent. There were no deaths in either group, and laparoscopic-assisted colectomy was associated with fewer morbidities (14.3 percent for laparoscopic-assisted colectomyvs. 33.3 percent for open colectomy;P=0.04), narcotic usage (2.7vs. 4.8 days;P<0.001), time to return to bowel movements (3.9vs. 5.9 days;P<0.001), and length of hospital stay (6.5vs. 10.2 days;P<0.001). Independent status at admission in 37 laparoscopic-assisted colectomy and 38 open colectomy patients was maintained at discharge by 35 laparoscopic-assisted colectomyvs. 29 open colectomy patients (P=0.025). CONCLUSIONS: Laparoscopic-assisted colectomy is safe and beneficial, including preservation of postoperative independence, to the elderly when compared with open colectomy.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dean PA, Beart RW Jr, Nelson H, Elftmann TD, Schlinkert RT. Laparoscopic-assisted segmental colectomy: early Mayo Clinic experience. Mayo Clin Proc 1994;69:834–40.

    PubMed  Google Scholar 

  2. Falk PM, Beart RW Jr, Wexner SD,et al. Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 1993;36:28–34.

    PubMed  Google Scholar 

  3. Hoffman GC, Baker JW, Fitchett CW, Vansant JH. Laparoscopic-assisted colectomy. Initial experience. Ann Surg 1994;219:732–40.

    PubMed  Google Scholar 

  4. Lord SA, Larach SW, Ferrara A, Williamson PR, Lago CP, Lube MW. Laparoscopic resections for colorectal carcinoma: a three-year experience. Dis Colon Rectum 1996;39:148–54.

    Article  PubMed  Google Scholar 

  5. Lumley JW, Fielding GA, Rhodes M, Nathanson LK, Siu S, Stitz RW. Laparoscopic-assisted colorectal surgery: lessons learned from 240 consecutive patients. Dis Colon Rectum 1996;39:155–9.

    Article  PubMed  Google Scholar 

  6. Peters WR, Bartels TL. Minimally invasive colectomy: are the potential benefits realized? Dis Colon Rectum 1993;36:751–6.

    Article  PubMed  Google Scholar 

  7. Khalili TM, Fleshner PR, Hiatt JR,et al. Colorectal cancer: comparison of laparoscopic with open approaches. Dis Colon Rectum 1998;41:832–8.

    Article  PubMed  Google Scholar 

  8. Lacy AM, Garcia-Valdecasas JC, Pique JM,et al. Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 1995;9:1101–5.

    PubMed  Google Scholar 

  9. Ortega AE, Beart RW Jr, Steele GD Jr, Winchester DP, Greene FL. Laparoscopic bowel surgery registry: preliminary results. Dis Colon Rectum 1995;38:681–5.

    Article  PubMed  Google Scholar 

  10. Franklin ME Jr, Rosenthal D, Abrego-Medina D,et al. Prospective comparison of openvs. laparoscopic colon surgery for carcinoma: five-year results. Dis Colon Rectum 1996;39(Suppl):S35–46.

    Article  PubMed  Google Scholar 

  11. Gellman L, Salky B, Edye M. Laparoscopic assisted colectomy. Surg Endosc 1996;10:1041–4.

    Article  PubMed  Google Scholar 

  12. Liberman MA, Phillips EH, Carroll BJ, Fallas M, Rosenthal R. Laparoscopic colectomy vs traditional colectomy for diverticulitis. Outcome and costs. Surg Endosc 1996;10:15–8.

    Article  PubMed  Google Scholar 

  13. Goh YC, Eu KW, Seow-Choen F. Early postoperative results of a prospective series of laparoscopicvs. open anterior resections for rectosigmoid cancers. Dis Colon Rectum 1997;40:776–80.

    Article  PubMed  Google Scholar 

  14. Djokovic JL, Hedley-Whyte J. Prediction of outcome of surgery and anesthesia in patients over 80. JAMA 1979;242:2301–6.

    Article  PubMed  Google Scholar 

  15. Wise WE Jr, Padmanabhan A, Meesig DM, Arnold MW, Aguilar PS, Stewart WR. Abdominal colon and rectal operations in the elderly. Dis Colon Rectum 1991;34:959–63.

    Article  PubMed  Google Scholar 

  16. Bender JS, Magnuson TH, Zenilman ME,et al. Outcome following colon surgery in the octogenarian. Am Surg 1996;62:276–9.

    PubMed  Google Scholar 

  17. Fallahzadeh H, Mays ET. Preexisting disease as a predictor of the outcome of colectomy. Am J Surg 1991;162:497–8.

    Article  PubMed  Google Scholar 

  18. Spivak H, Maele DV, Friedman I, Nussbaum M. Colorectal surgery in octogenarians. J Am Coll Surg 1996;183:46–50.

    PubMed  Google Scholar 

  19. Walsh TH. Audit of outcome of major surgery in the elderly. Br J Surg 1996;83:92–7.

    PubMed  Google Scholar 

  20. Whittle J, Steinberg EP, Anderson GF, Herbert R. Results of colectomy in elderly patients with colon cancer, based on Medicare claims data. Am J Surg 1992;163:572–6.

    Article  PubMed  Google Scholar 

  21. Frazee RC, Roberts JW, Okeson GC,et al. Open versus laparoscopic cholecystectomy. A comparison of post-operative pulmonary function. Ann Surg 1991;213:651–3.

    PubMed  Google Scholar 

  22. Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Elson P. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 1998;187:46–54.

    Article  PubMed  Google Scholar 

  23. Keats AS. The ASA classification of physical status—a recapitulation. Anesthesiology 1978;49:233–6.

    PubMed  Google Scholar 

  24. Stocchi L, Nelson H. Laparoscopic colectomy for colon cancer: trial update. J Surg Oncol 1998;68:255–67.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  27. Kranczer S. Banner year for U.S. longevity. Stat Bull Metrop Insur Co 1998;79:8–14.

    Google Scholar 

  28. Young-Fadok T, Radice E, Nelson H. Benefits of laparoscopic-assisted colectomy for colon polyps: a case-matched series. [meeting abstract] Dis Colon Rectum 1998;41:A47.

    Google Scholar 

  29. Senagore AJ, Luchtefeld MA, Mackeigan JM, Mazier WP. Open colectomy versus laparoscopic colectomy: are there differences? Am Surg 1993;59:549–53.

    PubMed  Google Scholar 

  30. Fleshman JW, Fry RD, Birnbaum EH, Kodner IJ. Laparoscopic-assisted and minilaparotomy approaches to colorectal diseases are similar in early outcome. Dis Colon Rectum 1996;39:15–22.

    Article  PubMed  Google Scholar 

  31. Franklin ME Jr, Rosenthal D, Norem RF. Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma. A multicenter study. Surg Endosc 1995;9:811–6.

    PubMed  Google Scholar 

  32. Harmon GD, Senagore AJ, Kilbride MJ, Warzynski MJ. Interleukin-6 response to laparoscopic and open colectomy. Dis Colon Rectum 1994;37:754–9.

    Google Scholar 

  33. Leung KL, Kwok SP, Lau WY,et al. Laparoscopic-assisted resection of rectosigmoid carcinoma. Immediate and medium-term results. Arch Surg 1997;132:761–4.

    PubMed  Google Scholar 

  34. Schoetz DJ Jr, Bockler M, Rosenblatt MS,et al. “Ideal” length of stay after colectomy: whose ideal? Dis Colon Rectum 1997;40:806–10.

    Article  PubMed  Google Scholar 

  35. Reissman P, Teoh TA, Cohen SM, Weiss EG, Nogueras JJ, Wexner SD. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg 1995;222:73–7.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Division of Colon and Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    L. Stocchi M.D.,  H. Nelson M.D. & T. M. Young-Fadok M.D.

  2. Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    D. R. Larson M.S. & D. M. Ilstrup M.S.

Authors
  1. L. Stocchi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Nelson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. M. Young-Fadok M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. R. Larson M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. M. Ilstrup M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Dr. Stocchi is a research fellow supported in part by Ethicon. Read at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.

About this article

Cite this article

Stocchi, L., Nelson, H., Young-Fadok, T.M. et al. Safety and advantages of laparoscopicvs. open colectomy in the elderly. Dis Colon Rectum 43, 326–332 (2000). https://doi.org/10.1007/BF02258297

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02258297

Key words

Search

Navigation