Abstract
Background
The steadily increasing age of the population mandates that potential benefits of new techniques and technologies be considered for older patients.
Aim
To analyze the short-term outcomes of laparoscopic (LAP) colorectal surgery in elderly compared to younger patients, and to patients who underwent laparotomy (OP).
Methods
A retrospective analysis of patients who underwent elective sigmoid colectomies for diverticular disease or ileo-colic resections for benign disorders; patients with stomas were excluded. There were two groups: age < 65 years (A) and age ≥ 65 years (B). Parameters included demographics, body mass index (BMI), length of operation (LO), incision length (LI), length of hospitalization (LOS), morbidity and mortality.
Results
641 patients (M/F – 292/349) were included between July 1991 and June 2006; 407 in group A and 234 in group B. There were significantly more LAP procedures in group A (244/407 – 60%) than in group B (106/234 – 45%) – p = 0.0003. Conversion rates were similar: 61/244 (25%) in group A, and 25/106 (24%) in group B (p = 0.78). There was no difference in LO between the groups in any type of operation. LOS was shorter in patients in group A who underwent OP: 7.1 (3–17) days versus 8.7 (4–22) days in group B (p <0.0001), and LAP: 5.3 (2–19) days versus 6.4 (2–34) days in group B (p = 0.01). In both groups LOS in the LAP group was significantly shorter than in OP group. There were no significant differences in major complications or mortality between the two groups; however, the complication rates in the OP groups were significantly higher than in LAP and CON combined (p = 0.003).
Conclusions
Elderly patients who undergo LAP have a significantly shorter LOS and fewer complications compared to elderly patients who undergo OP. Laparoscopy should be considered in all patients in whom ileo-colic or sigmoid resection is planned regardless of age.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Nelson H, Sargent D, Wieand HS, et al. for the Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 13;350(20):2050–2059
Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ (2001) Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 44(12):1800–1807
Khalili TM, Fleshner PR, Hiatt JR, Sokol TP, Manookian C, Tsushima G, Phillips EH (1998) Colorectal cancer: comparison of laparoscopic with open approaches. Dis Colon Rectum 41(7):832–838
Chen HH, Wexner SD, Weiss EG, Nogueras JJ, Alabaz O, Iroatulam AJ, Nessim A, Joo JS (1998) Laparoscopic colectomy for benign colorectal disease is associated with a significant reduction in disability as compared with laparotomy. Surg Endosc 12(12):1397–1400
Hong D, Lewis M, Tabet J, Anvari M (2002) Prospective comparison of laparoscopic versus open resection for benign colorectal disease. Surg Laparosc Endosc Percutan Tech 12(4):238–242
Thaler K, Dinnewitzer A, Mascha E, Arrigain S, Weiss EG, Nogueras JJ, Wexner SD (2003) Long-term outcome and health-related quality of life after laparoscopic and open colectomy for benign disease. Surg Endosc 17(9):1404–1408
Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238(1):67–72
Available at: http://www.census.gov/ipc/www/usinterimproj/ accessed December 20, 2006
Fruitman DS, MacDougall CE, Ross DB (1999) Cardiac surgery in octogenarians: can elderly patients benefit? Quality of life after cardiac surgery. Ann Thorac Surg 68(6):2129–2135
Kamolz T, Bammer T, Granderath FA, Pasiut M, Pointner R (2001) Quality of life and surgical outcome after laparoscopic antireflux surgery in the elderly gastroesophageal reflux disease patient. Scand J Gastroenterol 36(2):116–120
McConnell EJ, Tessier DJ, Wolff BG (2003) Population-based incidence of complicated diverticular disease of the sigmoid colon based on gender and age. Dis Colon Rectum 46(8):1110–1114
Schwandner O, Schiedeck TH, Bruch HP (1999) Advanced age -indication or contraindication for laparoscopic colorectal surgery. Dis Colon Rectum 42(3):356–362
Tekkis PP, Senagore AJ, Delaney CP (2005) Conversion rates in laparoscopic colorectal surgery: a predictive model with, 1253 patients. Surg Endosc 19(1):47–54
Iroatulam AJ, Chen HH, Potenti FM, Parameswaran S, Wexner SD (1999) Laparoscopic colectomy yields similar morbidity and disability regardless of patient age. Int J Colorectal Dis 14(3):155–157
Reissman P, Agachan F, Wexner SD (1996) Outcome of laparoscopic colorectal surgery in older patients. Am Surg 62(12):1060–1063
Stewart BT, Stitz BT, Lumley JW (1999) Laparoscopically assisted colorectal surgery in the elderly. Br J Surg 86(7):938–941
Law WL, Chu KW, Tung PH (2002) Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg 195(6):768–773
Author information
Authors and Affiliations
Corresponding author
Additional information
The study was accepted as a podium presentation in SAGES Scientific Sessions April 2007, Las Vegas, Nevada
Rights and permissions
About this article
Cite this article
Person, B., Cera, S.M., Sands, D.R. et al. Do elderly patients benefit from laparoscopic colorectal surgery?. Surg Endosc 22, 401–405 (2008). https://doi.org/10.1007/s00464-007-9412-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9412-8