Gerald Drews1, Beatrix Bohnsteen2, Jürgen Knolle3, Elise Gradhand4, Peter Würl5. 1. Department of General, Visceral and Thoracic Surgery, Municipal Hospital Dessau, Städtisches Klinikum Dessau, and Brandenburg Medical School Theodor Fontane, Auenweg 38, 06847, Dessau, Germany. gerald.drews@klinikum-dessau.de. 2. Oncological Outpatient Department, Kastanienhof 1, 06847, Dessau, Germany. 3. Institute of Pathology, Martha-Maria Hospital Halle-Dölau, Röntgenstraße 1, 06120, Halle (Saale), Germany. 4. Institute of Pathology, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany. 5. Department of General, Visceral and Thoracic Surgery, Municipal Hospital Dessau, Städtisches Klinikum Dessau, and Brandenburg Medical School Theodor Fontane, Auenweg 38, 06847, Dessau, Germany.
Abstract
PURPOSE: The use of laparoscopic surgery for colorectal cancer in elderly patients with high comorbidity is a controversial subject. This retrospective analysis aims to compare two different age groups with respect to short and long term clinical and oncological outcomes. METHODS: All laparoscopic colorectal resections for cancer performed between February 2011 and October 2017 with curative or palliative intention were evaluated. RESULTS: Among 128 completed resections, the rate of major complications, length of hospital stays, 30-day mortality, 2-year recurrence rate, and the survival after palliative surgery were comparable between group A (< 75 years; n = 76) and B (≥ 75 years; n = 52). Patients in group B showed an extraordinarily high proportion of ASA III stage (73.1% vs. A: 35.5%; p < 0.01) and, in this context, an increased rate of minor postoperative complications (17.3% vs. A: 6.6%; p < 0.05) and lower overall 2 and 5-year survival rates. Within the first 2 years, they died sooner in the event of recurrence (57.1% vs. A: 18.2%; p < 0.05), and their survival after rectal resection, especially for low rectal carcinoma, was significantly reduced (58.8% vs. A: 96.7%; p < 0.001). CONCLUSION: Laparoscopic surgery for colorectal cancer can be strongly advocated for elderly patients even in the face of high comorbidity. Whether very old patients with low rectal carcinoma also benefit from minimally invasive surgery or should undergo alternative therapies would need to be clarified primarily by examining the quality of life.
PURPOSE: The use of laparoscopic surgery for colorectal cancer in elderly patients with high comorbidity is a controversial subject. This retrospective analysis aims to compare two different age groups with respect to short and long term clinical and oncological outcomes. METHODS: All laparoscopic colorectal resections for cancer performed between February 2011 and October 2017 with curative or palliative intention were evaluated. RESULTS: Among 128 completed resections, the rate of major complications, length of hospital stays, 30-day mortality, 2-year recurrence rate, and the survival after palliative surgery were comparable between group A (< 75 years; n = 76) and B (≥ 75 years; n = 52). Patients in group B showed an extraordinarily high proportion of ASA III stage (73.1% vs. A: 35.5%; p < 0.01) and, in this context, an increased rate of minor postoperative complications (17.3% vs. A: 6.6%; p < 0.05) and lower overall 2 and 5-year survival rates. Within the first 2 years, they died sooner in the event of recurrence (57.1% vs. A: 18.2%; p < 0.05), and their survival after rectal resection, especially for low rectal carcinoma, was significantly reduced (58.8% vs. A: 96.7%; p < 0.001). CONCLUSION: Laparoscopic surgery for colorectal cancer can be strongly advocated for elderly patients even in the face of high comorbidity. Whether very old patients with low rectal carcinoma also benefit from minimally invasive surgery or should undergo alternative therapies would need to be clarified primarily by examining the quality of life.
Authors: Ruben Veldkamp; Esther Kuhry; Wim C J Hop; J Jeekel; G Kazemier; H Jaap Bonjer; Eva Haglind; Lars Påhlman; Miguel A Cuesta; Simon Msika; Mario Morino; Antonio M Lacy Journal: Lancet Oncol Date: 2005-07 Impact factor: 41.316
Authors: Antonio M Lacy; Juan C García-Valdecasas; Salvadora Delgado; Antoni Castells; Pilar Taurá; Josep M Piqué; Josep Visa Journal: Lancet Date: 2002-06-29 Impact factor: 79.321
Authors: Andrew T Schlussel; Conor P Delaney; Justin A Maykel; Michael B Lustik; Madhuri Nishtala; Scott R Steele Journal: Dis Colon Rectum Date: 2016-09 Impact factor: 4.585
Authors: Phil Quirke; Robert Steele; John Monson; Robert Grieve; Subhash Khanna; Jean Couture; Chris O'Callaghan; Arthur Sun Myint; Eric Bessell; Lindsay C Thompson; Mahesh Parmar; Richard J Stephens; David Sebag-Montefiore Journal: Lancet Date: 2009-03-07 Impact factor: 79.321