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Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients

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Abstract

Background

In surgical treatment of elderly patients, securing the safety of surgery and radical cure must be balanced. Our purpose was to verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients.

Methods

Patients with cTis–T4a colorectal cancer who were 75 years or older were randomized to receive open or laparoscopic surgery. Exclusion criteria were patients who had a bulky tumor, rectal cancer that required pelvic side wall lymphadenectomy, and history of colon resection. Patients were divided according to tumor location (right colon, left colon, and rectum). The short-term outcomes were compared between the two groups.

Results

One hundred patients (right 43, left 28, and rectum 29) were registered in each group from August 2008 to August 2012. There were no differences in patient characteristics between the two groups. Three patients were converted from laparoscopic to open, because of bleeding, excision of peritoneum metastasis, and patient’s desire, respectively. In the short-term results (open:laparoscopic), there were significant differences in the rates of complications (36:23 %) and ileus (12:4 %), amount of blood loss (157:63 mL), and duration of surgery (150:172 min). There were no significant differences in the pathological margins, and the number of dissected lymph nodes. In the subgroup analysis according to the tumor location, there were significant differences in the rate of complications (39.4:22.5 %), amount of blood loss (135:42 mL), duration of surgery (139:160 min), and length of postoperative stay (13.0:10.0 days) in the colon cancer. There were no significant differences in short-term results in the rectal cancer.

Conclusions

Laparoscopic surgery in elderly colorectal cancer patients did not result in a difference in radical cure compared with open surgery, and the short-term results except the duration of surgery were excellent. It is an effective procedure for elderly patients with colorectal cancer, especially colon cancer.

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References

  1. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, Brown JM (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82

    Article  CAS  PubMed  Google Scholar 

  2. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7

    Article  PubMed  Google Scholar 

  3. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H, Clinical Outcomes of Surgical Therapy Study Group (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662

    Article  PubMed  Google Scholar 

  4. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52

    Article  PubMed  Google Scholar 

  5. Ng Simon S, Leung KL, Lee JF, Yiu RY, Li JC, Hon SS (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum 52:558–566

    Article  CAS  PubMed  Google Scholar 

  6. Inomata M, Yasuda K, Shiraishi N, Kitano S (2009) Clinical evidences of laparoscopic versus open surgery for colorectal cancer. Jpn J Clin Oncol 39:471–477

    Article  PubMed  Google Scholar 

  7. Morris EJ, Jordan C, Thomas JD, Cooper M, Brown JM, Thorpe H, Cameron D, Forman D, Jayne D, Quirke P, CLASICC trialists (2011) Comparison of treatment and outcome information between a clinical trial and the National Cancer Data Repository. Br J Surg 98:299–307

    Article  CAS  PubMed  Google Scholar 

  8. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  9. Kitano S, Inomata M, Sato A, Yoshimura K, Moriya Y (2005) Randomized controlled trial to evaluate laparoscopic surgery for colorectal cancer. Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol 35:475–477

    Article  PubMed  Google Scholar 

  10. Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V (2008) Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 51:296–300

    Article  PubMed  Google Scholar 

  11. Tomimaru Y, Ide Y, Murata K (2011) Outcome of laparoscopic surgery for colon cancer in elderly patients. Asian J Endosc Surg 4:1–6

    Article  CAS  PubMed  Google Scholar 

  12. Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138:252–256

    Article  PubMed  Google Scholar 

  13. Vignali A, Di Palo S, Tamburini A, Radaelli G, Orsenigo E, Staudacher C (2005) Laparoscopic vs. open colectomies in octogenarians: a case-matched control study. Dis Colon Rectum 48:2070–2075

    Article  PubMed  Google Scholar 

  14. Tei M, Ikeda M, Haraguchi N, Takemasa I, Mizushima T, Ishii H, Yamamoto H, Sekimoto M, Doki Y, Mori M (2009) Postoperative complications in elderly patients with colorectal cancer: comparison of open and laparoscopic surgical procedures. Surg Laparosc Endosc Percutan Tech 19:488–492

    Article  PubMed  Google Scholar 

  15. Tuech JJ, Pessaux P, Rouge C, Regenet N, Bergamaschi R, Arnaud JP (2000) Laparoscopic vs open colectomy for sigmoid diverticulitis: a prospective comparative study in the elderly. Surg Endosc 14:1031–1033

    Article  CAS  PubMed  Google Scholar 

  16. Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM (2000) Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study. Dis Colon Rectum 43:326–332

    Article  CAS  PubMed  Google Scholar 

  17. Stewart BT, Stitz RW, Lumley JW (1999) Laparoscopically assisted colorectal surgery in the elderly. Br J Surg 86:938–941

    Article  CAS  PubMed  Google Scholar 

  18. Sklow B, Read T, Birnbaum E, Fry R, Fleshman J (2003) Age and type of procedure influence the choice of patients for laparoscopic colectomy. Surg Endosc 17:923–929

    Article  CAS  PubMed  Google Scholar 

  19. Lian L, Kalady M, Geisler D, Kiran RP (2010) Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians. Surg Endosc 24:2039–2043

    Article  PubMed  Google Scholar 

  20. Law WL, Chu KW, Tung PH (2002) Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg 195:768–773

    Article  PubMed  Google Scholar 

  21. She WH, Poon JT, Fan JK, Lo OS, Law WL (2013) Outcome of laparoscopic colectomy for cancer in elderly patients. Surg Endosc 27:308–312

    Article  PubMed  Google Scholar 

  22. Robinson CN, Balentine CJ, Marshall CL, Wilks JA, Anaya D, Artinyan A, Berger DH, Albo D (2011) Minimally invasive surgery improves short-term outcomes in elderly colorectal cancer patients. J Surg Res 166:182–188

    Article  PubMed  Google Scholar 

  23. Grailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P, Faiz O (2013) Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc 27:19–30

    Article  PubMed  Google Scholar 

  24. Mori T, Kimura T, Kitajima M (2010) Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol 19:18–23

    Article  PubMed  Google Scholar 

  25. Colorectal Cancer Society (2006) The 7th edition of the Japanese general rules for clinical and pathological studies on cancer of the colon, rectum and anus. Kanahara Publications, Tokyo

    Google Scholar 

  26. Eastern Cooperative Oncology Group (1999) Common toxicity criteria, version 2.0. http://ctep.info.nih.gov/protocolDevelopment/electronic_applications/docs/ctcv20_4-30-992.pdf

  27. International Union Against Cancer (2010) TNM classification of malignant tumors, 7th edn. Wiley-Liss, New York

    Google Scholar 

  28. National Cancer Institute. Common terminology criteria for adverse events, version 4.0. http://www.eortc.be/services/doc/ctc/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf#search=’Common+Terminology+Criteria+for+Adverse+Events+version+4.0.3

  29. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

  30. Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K (1998) Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. J Clin Epidemiol 51:1037–1044

    Article  CAS  PubMed  Google Scholar 

  31. Japan Cabinet Office. [White paper on aging society]. http://www8.cao.go.jp/kourei/whitepaper/w-2012/zenbun/24pdf_index.htm

  32. Japan Society for Endoscopic Surgery (2012) Survey of endoscopic surgery in Japan. J Jpn Soc Endosc Surg 17:571–679

    Google Scholar 

  33. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial); multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  34. Miyajima N, Fukunaga M, Hasegawa H, Tanaka J, Okuda J, Watanabe M (2009) Results of a multicenter study of 1,057 cases of rectal cancer treated by laparoscopic surgery. Surg Endosc 23:113–118

    Article  PubMed  Google Scholar 

  35. da Luz MoreiraA, Kiran RP, Kirat HT, Remzi FH, Geisler DP, Church JM, Garofalo T, Fazio VW (2010) Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc 24:1280–1286

    Article  Google Scholar 

  36. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  PubMed  Google Scholar 

  37. Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N (2008) Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 23:703–707

    Article  PubMed  Google Scholar 

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Disclosures

Shoichi Fujii, Atsushi Ishibe, Mitsuyoshi Ota, Shigeru Yamagishi, Kazuteru Watanabe, Jun Watanabe, Amane Kanazawa, Yasushi Ichikawa, Mari Oba, Satoshi Morita, Yojiro Hashiguchi, Chikara Kunisaki, and Itaru Endo have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan

    Shoichi Fujii, Atsushi Ishibe, Mitsuyoshi Ota, Shigeru Yamagishi, Amane Kanazawa & Chikara Kunisaki

  2. Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan

    Shoichi Fujii & Yojiro Hashiguchi

  3. Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine, 4-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Kazuteru Watanabe, Jun Watanabe, Yasushi Ichikawa & Itaru Endo

  4. Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan

    Mari Oba & Satoshi Morita

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  1. Shoichi Fujii
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  2. Atsushi Ishibe
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Correspondence to Shoichi Fujii.

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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 28, 466–476 (2014). https://doi.org/10.1007/s00464-013-3223-x

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  • DOI: https://doi.org/10.1007/s00464-013-3223-x

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