Seiichiro Yamamoto1, Takao Hinoi2,3, Hiroaki Niitsu2, Masazumi Okajima4, Yoshihito Ide5, Kohei Murata5, Shintaro Akamoto6, Akiyoshi Kanazawa7, Masayoshi Nakanishi8, Takeshi Naitoh9, Eiji Kanehira10, Tsukasa Shimamura11, Ichio Suzuka12, Yosuke Fukunaga13, Takashi Yamaguchi14, Masahiko Watanabe15. 1. Division of Gastrointestinal Surgery, Hiratsuka City Hospital, 19-1-1, Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan. miyamamo@jcom.home.ne.jp. 2. Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 3. Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan. 4. Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. 5. Department of Surgery, Suita Municipal Hospital, Suita, Japan. 6. Department of Gastroenterological Surgery, Kagawa University Hospital, Kagawa, Japan. 7. Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan. 8. Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 9. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 10. Department of Surgery, Ageo Central General Hospital, Ageo, Japan. 11. Department of Gastroenterological Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. 12. Department of Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan. 13. Department of Surgery, Cancer Institute Ariake Hospital, Tokyo, Japan. 14. National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 15. Department of Surgery, Kitasato University Hospital, Sagamihara, Japan.
Abstract
BACKGROUND: The aim of the present study was to examine the technical and oncological feasibility of laparoscopic surgery (LAP) in elderly patients with a history of abdominal surgery. METHODS: We conducted a propensity score-matched case-control study of colorectal cancer (CRC) patients aged ≥80 years that were treated at 41 hospitals between 2003 and 2007. We included 601 patients who had a history of abdominal surgery and underwent curative and elective surgery for stage 0 to III CRC. After the matching procedure, 153 patients were included in each cohort. The surgical outcomes of LAP and open surgery (OS) were compared. P-values of <0.05 were considered statistically significant. RESULTS: LAP resulted in a significantly longer surgical time (220 vs. 170 min, p < 0.001), but significantly less intraoperative blood loss (39 vs. 100 ml, p < 0.001). A number of postoperative recovery-related parameters, including the length of the hospitalization period (12 vs. 14 days, p = 0.002), and the days to the resumption of fluid (2 vs. 3 days, p < 0.001) and solid food intake (4 vs. 5 days, p < 0.001), were significantly better in the LAP group. Moreover, the overall morbidity rate (43 vs. 66 %, p = 0.009) and the frequency of postoperative ileus (7 vs. 19 %, p = 0.023) were significantly lower in the LAP group, while the frequencies of other morbidities did not differ significantly between the groups. In the survival analyses, overall survival and disease-free survival did not differ between the two groups. CONCLUSIONS: In this population, LAP can be performed safely in elderly CRC patients with a history of abdominal surgery, and LAP resulted in a lower postoperative morbidity rate than OS.
BACKGROUND: The aim of the present study was to examine the technical and oncological feasibility of laparoscopic surgery (LAP) in elderly patients with a history of abdominal surgery. METHODS: We conducted a propensity score-matched case-control study of colorectal cancer (CRC) patients aged ≥80 years that were treated at 41 hospitals between 2003 and 2007. We included 601 patients who had a history of abdominal surgery and underwent curative and elective surgery for stage 0 to III CRC. After the matching procedure, 153 patients were included in each cohort. The surgical outcomes of LAP and open surgery (OS) were compared. P-values of <0.05 were considered statistically significant. RESULTS: LAP resulted in a significantly longer surgical time (220 vs. 170 min, p < 0.001), but significantly less intraoperative blood loss (39 vs. 100 ml, p < 0.001). A number of postoperative recovery-related parameters, including the length of the hospitalization period (12 vs. 14 days, p = 0.002), and the days to the resumption of fluid (2 vs. 3 days, p < 0.001) and solid food intake (4 vs. 5 days, p < 0.001), were significantly better in the LAP group. Moreover, the overall morbidity rate (43 vs. 66 %, p = 0.009) and the frequency of postoperative ileus (7 vs. 19 %, p = 0.023) were significantly lower in the LAP group, while the frequencies of other morbidities did not differ significantly between the groups. In the survival analyses, overall survival and disease-free survival did not differ between the two groups. CONCLUSIONS: In this population, LAP can be performed safely in elderly CRCpatients with a history of abdominal surgery, and LAP resulted in a lower postoperative morbidity rate than OS.
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