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Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case–control assessment

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Abstract

Background

To evaluate the effectiveness of laparoscopic surgery (LCS) for colon and rectal cancer in the very elderly over 80 years old.

Methods

We performed a prospective multicentric analysis comparing patients over 80 years (Group A) and patients between 60 and 69 years (Group B) undergoing LCS for cancer from January 2008 to December 2013. Colon and rectal cancers were analyzed separately. Comorbidity and complications were classified using the Charlson comorbidity index (CCI) and the Clavien–Dindo system, respectively. Oncological parameters included tumor-free margins, number of lymph nodes harvested and circumferential resection margin.

Results

Group A included 96 and 33 patients, and Group B 220 and 82 for colon and rectal cancers, respectively. Groups were similar except for ASA score and CCI, as expected. There was no significant difference in operative time [colon; rectum] (180[IQR 150–200] vs 180[150–210] min; NS—180[160–210] vs 180[165–240] min; NS), estimated blood loss (50[25–75] vs 50[25–120] mL; NS—50[0–150] vs 50[25–108.7] mL; NS) and conversion rate (2.1 vs 2.7 %; NS—3.0 vs 2.4 %; NS). Timing of first stool (3[2–3.25] vs 3[2–5] dd; NS—3[2–4] vs 3[2–5] dd; NS), length of stay (7[6–8] vs 7[6–8] dd; NS—8[8–9] vs 8[7–9] dd; NS) and readmission rate (1.0 vs 0.45 %; NS—6.1 vs 1.2 %; NS) were similar. Tumor-free margins were appropriate, and positivity of CRM is poor (6.1 vs 4.9; NS). We did not record significant differences in complications rate (47.9 vs 43.6 %; NS—63.6 vs 52.4 %; NS).

Conclusions

Laparoscopic surgery is effective for the treatment of colorectal cancer even in the very elderly. Age is not a risk factor or a limitation for LCS.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Galmarini Hospital, Piazzale A. Zanaboni, 1, 21049, Tradate, Italy

    Francesco Roscio, Federico Clerici, Paolo Frattini & Ildo Scandroglio

  2. PhD Program in Surgery and Surgical Biotechnologies, University of Insubria, Varese, Italy

    Francesco Roscio & Luigi Boni

  3. Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy

    Luigi Boni & Elisa Cassinotti

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  1. Francesco Roscio
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  3. Federico Clerici
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Correspondence to Francesco Roscio.

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Francesco Roscio, Luigi Boni, Federico Clerici, Paolo Frattini, Elisa Cassinotti and Ildo Scandroglio have no conflicts of interest or financial ties to disclose.

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Roscio, F., Boni, L., Clerici, F. et al. Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case–control assessment. Surg Endosc 30, 4372–4382 (2016). https://doi.org/10.1007/s00464-016-4755-7

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