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Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case–control study in Japan

  • Original Article—Alimentary Tract
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Abstract

Background

It remains controversial whether open or laparoscopic surgery should be indicated for elderly patients with colorectal cancer and a poor performance status.

Methods

In those patients aged 80 years or older with Eastern Cooperative Oncology Group performance status score of 2 or greater who received elective surgery for stage 0 to stage III colorectal adenocarcinoma and had no concomitant malignancies and who were enrolled in a multicenter case–control study entitled “Retrospective study of laparoscopic colorectal surgery for elderly patients” that was conducted in Japan between 2003 and 2007, background characteristics and short-term and long-term outcomes for open surgery and laparoscopic surgery were compared.

Results

Of the 398 patients included, 295 underwent open surgery and 103 underwent laparoscopic surgery. There were no significant differences in the baseline characteristics between open surgery and laparoscopic surgery patients, except for previous abdominal surgery and TNM stage. The median operation duration was shorter with open surgery (open surgery, 153 min; laparoscopic surgery, 202 min; P < 0.001), and less blood loss occurred with laparoscopic surgery (median open surgery, 109 g; median laparoscopic surgery, 30 g; P < 0.001). An operation duration of 180 min or more (odds ratio, 1.97; 95 % confidence interval, 1.17–3.37; P = 0.011) and selection of laparoscopic surgery (odds ratio, 0.41; 95 % confidence interval, 0.22–0.75; P = 0.003) were statistically significant in the multivariate analysis for postoperative morbidity. Moreover, laparoscopic surgery did not result in an inferior overall survival rate compared with open surgery (log-rank test P = 0.289, 0.278, 0.346, 0.199, for all-stage, stage 0–I, stage II, and stage III disease, respectively).

Conclusions

Laparoscopic surgery in elderly colorectal cancer patients with a poor performance status is safe and not inferior to open surgery in terms of overall survival.

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Acknowledgments

We appreciate the great support with the statistical analyses provided by Minoru Hattori, Advanced Medical Skills Training Center, Hiroshima University, and we owe our deepest gratitude to the following members of the Japan Society of Laparoscopic Colorectal Surgery for their cooperation: Eiji Kanehira, Kunihisa Shiozawa, Ageo Central General Hospital; Hiroyuki Bando, Daisuke Yamamoto, Ishikawa Prefectural Central Hospital; Seigo Kitano, Masafumi Inomata, Tomonori Akagi, Oita University; Junji Okuda, Keitaro Tanaka, Osaka Medical College; Masayoshi Yasui, Osaka National Hospital; Kosei Hirakawa, Kiyoshi Maeda, Osaka City University; Akiyoshi Kanazawa, Osaka Red Cross Hospital; Junichi Hasegawa, Junichi Nishimura, Osaka Rosai Hospital; Shintaro Akamoto, Kagawa University; Masashi Ueno, Hiroya Kuroyanagi, Cancer Institute Hospital; Masaki Naito, Kitasato University; Takashi Ueki, Kyushu University; Yoshiharu Sakai, Koya Hida, Yousuke Kinjo, Kyoto University; Yukihito Kokuba, Kyoto Prefectural University; Madoka Hamada, Kochi Health Sciences Center; Norio Saito, Masaaki Ito, National Cancer Hospital East; Shigeki Yamaguchi, Jou Tashiro, Saitama Medical University International Medical Center; Toshimasa Yatsuoka, Saitama Cancer Center; Tomohisa Furuhata, Kenji Okita, Sapporo Medical University; Yoshiro Kubo, Shikoku Cancer Center; Shuji Saito, Yosuke Kinugasa, Shizuoka Cancer Center; Fumio Konishi, Saitama Medical Center Jichi Medical University; Kazuhiro Sakamoto, Michitoshi Goto, Juntendo University; Junichi Tanaka, Showa University Northern Yokohama Hospital; Nobuyoshi Miyajima, Tadashi Suda, Tsukasa Shimamura, St. Marianna University; Yoshihisa Saida, Toshiyuki Enomoto, Toho University Ohashi Medical Center; Takeshi Naito, Tohoku University; Yasuhiro Munakata, Ken Hayashi, Nagano Municipal Hospital; Yasukimi Takii, Satoshi Maruyama, Niigata Cancer Center Hospital; Yohei Kurose, Fukuyama City Hospital; Yasuhiro Miyake, Minoh City Hospital; Shoichi Hazama, Yamaguchi University; Shoich Fujii, Shigeru Yamagishi, Yokohama City University Medical Center; Masazumi Okajima, Hiroshima City Hiroshima Citizens Hospital; Seiichiro Yamamoto, National Cancer Center Hospital; Hisanaga Horie, Jichi Medical University; Kohei Murata, Suita Municipal Hospital; and Kenichi Sugihara, Tokyo Medical and Dental University Graduate School. This study was supported by the Japanese Society for Cancer of the Colon and Rectum.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Author notes

  1. Shungo Endo

    Present address: Aizu Medical Center, Fukushima Medical University, Fukushima, Japan

  2. Soichi Tagami

    Present address: Department of Surgery, Shohnan Tobu General Hospital, Kanagawa, Japan

  3. Hitoshi Idani

    Present address: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

  4. Takao Ichihara

    Present address: Digestive Disease Center, Amagasaki Chuo Hospital, Hyogo, Japan

  5. Kazuteru Watanabe

    Present address: NTT Medical Center Tokyo, Tokyo, Japan

  6. Ichio Suzuka

    Present address: Department of Surgery, Ako Central Hospital, Hyogo, Japan

Authors and Affiliations

  1. Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan

    Hiroaki Niitsu, Takao Hinoi, Yasuo Kawaguchi & Hideki Ohdan

  2. Department of Surgery, Keio University, Tokyo, Japan

    Hirotoshi Hasegawa

  3. Department of Gastrointestinal and General Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan

    Ichio Suzuka

  4. Department of Surgery, Cancer Institute Hospital, Tokyo, Japan

    Yosuke Fukunaga

  5. Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Takashi Yamaguchi

  6. Digestive Disease Center, Northern Yokohama Hospital, Showa University, Yokohama, Japan

    Shungo Endo

  7. Department of Surgery, Nagano Municipal Hospital, Nagano, Japan

    Soichi Tagami

  8. Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan

    Hitoshi Idani

  9. Department of Surgery, Nishinomiya Municipal Central Hospital, Hyogo, Japan

    Takao Ichihara

  10. Department of Gastroenterological Surgery, Yokohama City University Medical Center, Kanagawa, Japan

    Kazuteru Watanabe

  11. Department of Surgery, Kitasato University, Sagamihara, Japan

    Masahiko Watanabe

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  1. Hiroaki Niitsu
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  2. Takao Hinoi
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  8. Takashi Yamaguchi
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  9. Shungo Endo
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  12. Takao Ichihara
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  14. Masahiko Watanabe
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The Japan Society of Laparoscopic Colorectal Surgery

Corresponding author

Correspondence to Takao Hinoi.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (TIFF 6593 kb)

Electronic supplementary material 1: Morbitidy (a) and overall survival (b) compared between the levels of the performance status in the case–control study entitled “Retrospective study of laparoscopic colorectal surgery for elderly patients”

Supplementary material 2 (TIFF 6593 kb)

Electronic supplementary material 2: The reported use of each operative procedure compared between the levels of performance status in the case–control study entitled “Retrospective study of laparoscopic colorectal surgery for elderly patients.” a Number of each operative procedures, and b proportion of each operative procedure. LAP laparoscopic surgery, OP open surgery

Supplementary material 3 (TIFF 6592 kb)

Electronic supplementary material 3: Comparison of disease-free survival between the surgical approaches: a all-stage disease; b stage 0-I disease; c stage II disease; d stage III disease.

Data are summarized as the hazard ratio (HR) with the 95 % confidence interval (CI) and P value based on a log-rank test. LAP laparoscopic surgery, OP open surgery

Supplementary material 4 (TIFF 8490 kb)

Electronic supplementary material 4: Comparison of the morbidity rate between operative procedures and durations. LAP laparoscopic surgery, N.S. not significant, OP open surgery

Supplementary material 5 (TIFF 6593 kb)

Electronic supplementary material 5: Comparison between the institutions for approach selection in elderly patients with colorectal cancer. LAP laparoscopic surgery, OP open surgery

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Niitsu, H., Hinoi, T., Kawaguchi, Y. et al. Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case–control study in Japan. J Gastroenterol 51, 43–54 (2016). https://doi.org/10.1007/s00535-015-1083-y

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  • DOI: https://doi.org/10.1007/s00535-015-1083-y

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