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Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients

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Abstract

Background

Increasing life expectancy requires specific attention on geriatric patients. Data support a potential reduction of surgical morbidity for patients undergoing laparoscopic surgery as compared to conventional surgery. The aim of this study was to investigate the comparative effect of laparoscopic and open colorectal surgery on geriatric patients.

Methods

A systematic review of electronic information sources was undertaken. Studies that provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open colorectal surgery, were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was independently appraised by two reviewers. Random effects model was applied to synthesize outcome data.

Results

Twenty-seven articles providing data for 66,592 patients were included in the analysis. Patients undergoing laparoscopic surgery had a decreased risk for mortality (2.2 vs. 5.4 %; OR 0.55, 95 % CI 0.44–0.67), overall morbidity (19.3 vs. 26.7 %; OR 0.54, 95 % CI 0.46–0.63), cardiac (4.7 vs. 7.7 %; OR 0.60, 95 % CI 0.39–0.92) and respiratory complications (3.9 vs. 6.3 %; OR 0.67, 95 % CI 0.47–0.95). Sensitivity analysis including reports with similar age, American Society of Anesthesiologists score and/or similar prevalence of cardiopulmonary morbidity between the laparoscopic and the open treatment arm validated the outcome estimates of the primary analysis.

Conclusions

This analysis supports a substantial benefit for elderly patients undergoing laparoscopic in comparison with open colorectal surgery. The comparative effect of either approach on geriatric patients with pulmonary and cardiac comorbidities is a subject of further investigation.

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Acknowledgments

The authors are grateful to Ms. Aggeliki Zachou, clinical librarian, for her kind and continuous support.

Disclosures

Drs. S. A. Antoniou, G. A. Antoniou, O. O. Koch, R. Pointner and F. A. Granderath have no conflict of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany

    Stavros Athanasios Antoniou & Frank-Alexander Granderath

  2. Department of General Surgery, University General Hospital of Heraklion, Crete, Greece

    Stavros Athanasios Antoniou

  3. Department of Vascular Surgery, Red Cross Hospital, Athens, Greece

    George Athanasios Antoniou

  4. Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria

    Oliver Owen Koch

  5. Department of General and Visceral Surgery, Hospital Zell am See, Zell am See, Austria

    Rudolph Pointner

  6. Athinon-Souniou 11, 19001, Keratea Attikis, Athens, Greece

    Stavros Athanasios Antoniou

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  1. Stavros Athanasios Antoniou
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Correspondence to Stavros Athanasios Antoniou.

Appendix

Appendix

See Tables 3 and 4.

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Table 4 Quality assessment of randomized studies
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Antoniou, S.A., Antoniou, G.A., Koch, O.O. et al. Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients. Surg Endosc 29, 322–333 (2015). https://doi.org/10.1007/s00464-014-3672-x

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