PURPOSE: Short-term and midterm outcomes of surgery remain unclear in very elderly patients (≥85 y) with colorectal cancer. This study was designed to clarify the safety and therapeutic usefulness of surgery for colorectal cancer in this subgroup of patients. We compared postoperative short-term and midterm outcomes between laparoscopic surgery and open surgery to evaluate the feasibility of laparoscopic surgery in very elderly patients. MATERIALS AND METHODS: The study group comprised 80 patients [38 men (48%) and 42 women (52%)] aged 85 years or older who had colorectal cancer and were treated in our department from 1987 to 2010. The mean age was 87.3±2.3 years, and the median follow-up was 45 months (range, 4 to 252 mo). Sixty-nine patients (86%) were 85 to 89 years old, and 11 (14%) were aged 90 years or older. The American Society of Anesthesiologists' (ASA) risk class was I in 2 patients (2%), II in 44 (55%), and III in 34 (43%). Open surgery was performed in 46 patients (58%), and laparoscopic surgery was performed in 34 patients (42%). RESULTS: The ASA risk class was II or III in 78 patients (98%). Postoperative complications occurred in 21 patients (26%), including ileus in 8 patients (10%), wound infection in 7 (9%), and anastomotic leakage in 3 (4%). As compared with open surgery, laparoscopic surgery had significantly lower intraoperative blood loss (P<0.0001) and a significantly shorter postoperative hospital stay (P=0.0001) but required a significantly longer operation time (P=0.0017). Clinicopathologically, laparoscopic surgery was associated with a significantly smaller tumor size (P=0.0371), significantly fewer dissected lymph nodes (P=0.0181), and significantly fewer patients with stage II or III disease (P=0.0090). Postoperative complications occurred in 14 patients (30%) in the open surgery group and 6 (18%) in the laparoscopic surgery group, but this difference was not significant. As for midterm outcomes, the disease-free survival rate and the overall survival rate were, respectively, 90.9% and 100% in stage I disease, 89.7% and 100% in stage II disease, and 68.4% and 75.9% in stage III disease. CONCLUSIONS: Colorectal surgery was safe, therapeutically useful, and had good short-term and midterm outcomes in very elderly patients with colorectal cancer. As compared with open surgery, laparoscopic surgery was associated with lower intraoperative blood loss and a shorter postoperative hospital stay. These results suggest that laparoscopic surgery is suitable for very elderly patients with colorectal cancer because it is less invasive than open surgery.
PURPOSE: Short-term and midterm outcomes of surgery remain unclear in very elderly patients (≥85 y) with colorectal cancer. This study was designed to clarify the safety and therapeutic usefulness of surgery for colorectal cancer in this subgroup of patients. We compared postoperative short-term and midterm outcomes between laparoscopic surgery and open surgery to evaluate the feasibility of laparoscopic surgery in very elderly patients. MATERIALS AND METHODS: The study group comprised 80 patients [38 men (48%) and 42 women (52%)] aged 85 years or older who had colorectal cancer and were treated in our department from 1987 to 2010. The mean age was 87.3±2.3 years, and the median follow-up was 45 months (range, 4 to 252 mo). Sixty-nine patients (86%) were 85 to 89 years old, and 11 (14%) were aged 90 years or older. The American Society of Anesthesiologists' (ASA) risk class was I in 2 patients (2%), II in 44 (55%), and III in 34 (43%). Open surgery was performed in 46 patients (58%), and laparoscopic surgery was performed in 34 patients (42%). RESULTS: The ASA risk class was II or III in 78 patients (98%). Postoperative complications occurred in 21 patients (26%), including ileus in 8 patients (10%), wound infection in 7 (9%), and anastomotic leakage in 3 (4%). As compared with open surgery, laparoscopic surgery had significantly lower intraoperative blood loss (P<0.0001) and a significantly shorter postoperative hospital stay (P=0.0001) but required a significantly longer operation time (P=0.0017). Clinicopathologically, laparoscopic surgery was associated with a significantly smaller tumor size (P=0.0371), significantly fewer dissected lymph nodes (P=0.0181), and significantly fewer patients with stage II or III disease (P=0.0090). Postoperative complications occurred in 14 patients (30%) in the open surgery group and 6 (18%) in the laparoscopic surgery group, but this difference was not significant. As for midterm outcomes, the disease-free survival rate and the overall survival rate were, respectively, 90.9% and 100% in stage I disease, 89.7% and 100% in stage II disease, and 68.4% and 75.9% in stage III disease. CONCLUSIONS: Colorectal surgery was safe, therapeutically useful, and had good short-term and midterm outcomes in very elderly patients with colorectal cancer. As compared with open surgery, laparoscopic surgery was associated with lower intraoperative blood loss and a shorter postoperative hospital stay. These results suggest that laparoscopic surgery is suitable for very elderly patients with colorectal cancer because it is less invasive than open surgery.
Authors: X Serra-Aracil; S Serra-Pla; L Mora-Lopez; A Pallisera-Lloveras; M Labro-Ciurans; S Navarro-Soto Journal: Surg Endosc Date: 2018-06-22 Impact factor: 4.584