Korean J Gastroenterol.  2017 May;69(5):291-297. 10.4166/kjg.2017.69.5.291.

The Short-term Outcome and Safety of Laparoscopic Colorectal Cancer Resection in Very Elderly Patients

• Jung WB
• Shin JY
• Suh BJ

• KMID: 2383387
• DOI: http://doi.org/10.4166/kjg.2017.69.5.291

Abstract

BACKGROUND/AIMS
Due to the recent increase in elderly population, laparoscopic surgery is more frequently performed in the elderly. This study aimed to compare the short-term outcomes of laparoscopic colorectal cancer surgery between the very elderly group (VEG), categorized as those with age over 80 years and the elderly group (EG), categorized as those with age 65 to 79 years.
METHODS
We retrospectively compared 48 very elderly patients with 96 elderly patients (1:2 matched) who underwent laparoscopic resection for colorectal cancers at our institution between March 2010 and December 2014. The clinicopathologic parameters, surgical characteristics and short term outcomes were compared.
RESULTS
There was no statistically significant difference in clinicopathologic characteristics between VEG and EG. Postoperative pain score (7 points vs. 6 points, p=0.264), time to first flatus (3 days vs. 3 days, p=0.335), hospital stay (15 days vs. 16.5 days, p=0.361), complication rates (47.9% vs. 26.0%, p=0.147) and major complication rate (25% vs. 20.8%, p=0.681) were not statistically different between the two groups. Before surgery, VEG had higher rate of neurologic underlying disease, such as dementia or cerebrovascular disease, than EG (25.0% vs. 7.3%, p=0.007).
CONCLUSIONS
There was no significant difference in the clinicopathologic characteristics, short-term outcomes, and complication rates for laparoscopic colorectal resection between VEG and EG, except delirium. Age over 80 years may be relevant for the application of laparoscopic colorectal cancer resection.

Keyword

Laparoscopic surgery; Colorectal cancer; Mordidity; Elderly

MeSH Terms

Aged*
Cerebrovascular Disorders
Colorectal Neoplasms*
Delirium
Dementia
Flatulence
Humans
Laparoscopy
Length of Stay
Pain, Postoperative
Retrospective Studies

Figure

• 

  Fig. 1 Overall study design and overview of patient population. CRC, colorectal cancer.

Reference

1. Law WL, Chu KW, Tung PH. Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg. 2002; 195:768–773.

2. Cha JM. Colonoscopy quality is the answer for the emerging issue of interval cancer. Intest Res. 2014; 12:110–116.

3. Park SH, Song CW, Kim YB, et al. Clinicopathological characteristics of colon cancer diagnosed at primary health care institutions. Intest Res. 2014; 12:131–138.

4. Toyota M, Ahuja N, Ohe-Toyota M, Herman JG, Baylin SB, Issa JP. CpG island methylator phenotype in colorectal cancer. Proc Natl Acad Sci U S A. 1999; 96:8681–8686.

5. Vignali A, Di Palo S, Tamburini A, Radaelli G, Orsenigo E, Staudacher C. Laparoscopic vs. open colectomies in octogenarians: a case-matched control study. Dis Colon Rectum. 2005; 48:2070–2075.

6. Fielding LP, Phillips RK, Hittinger R. Factors influencing mortality after curative resection for large bowel cancer in elderly patients. Lancet. 1989; 1:595–597.

7. Verweij NM, Schiphorst AH, Maas HA, et al. Colorectal cancer resections in the oldest old between 2011 and 2012 in the Netherlands. Ann Surg Oncol. 2016; 23:1875–1882.

8. Tan WS, Chew MH, Lim IA, Ng KH, Tang CL, Eu KW. Evaluation of laparoscopic versus open colorectal surgery in elderly patients more than 70 years old: an evaluation of 727 patients. Int J Colorectal Dis. 2012; 27:773–780.

9. Fujii S, Ishibe A, Ota M, et al. Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients. Surg Endosc. 2014; 28:466–476.

10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213.

11. Egner JR. AJCC cancer staging manual. JAMA. 2010; 304:1726–1727.

12. Washington MK, Berlin J, Branton P, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med. 2009; 133:1539–1551.

13. Kim YW, Kim NK, Min BS, et al. Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients. J Surg Oncol. 2009; 99:58–64.

14. Duron JJ, Duron E, Dugue T, et al. Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg. 2011; 254:375–382.

15. Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006; 203:865–877.

16. Yamamoto S, Watanabe M, Hasegawa H, Baba H, Kitajima M. Short-term surgical outcomes of laparoscopic colonic surgery in octogenarians: a matched case-control study. Surg Laparosc Endosc Percutan Tech. 2003; 13:95–100.

17. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five‐year follow‐up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010; 97:1638–1645.

18. Schwenk W, Böhm B, Müller JM. Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial. Surg Endosc. 1998; 12:1131–1136.

19. Tominaga T, Takeshita H, Arai J, et al. Short-term outcomes of laparoscopic surgery for colorectal cancer in oldest-old patients. Dig Surg. 2015; 32:32–38.

20. Yap R, Oliva K, Wilkins S, McMurrick PJ. Colorectal cancer surgery in the very elderly: nonagenarians. Dis Colon Rectum. 2016; 59:501–507.

21. Person B, Cera SM, Sands DR, et al. Do elderly patients benefit from laparoscopic colorectal surgery? Surg Endosc. 2008; 22:401–405.

22. Akiyoshi T, Kuroyanagi H, Oya M, et al. Short-term outcomes of laparoscopic rectal surgery for primary rectal cancer in elderly patients: is it safe and beneficial? J Gastrointest Surg. 2009; 13:1614–1618.

23. Hinoi T, Kawaguchi Y, Hattori M, et al. Laparoscopic versus open surgery for colorectal cancer in elderly patients: a multicenter matched case-control study. Ann Surg Oncol. 2015; 22:2040–2050.

24. Nakamura T, Sato T, Miura H, et al. Feasibility and outcomes of surgical therapy in very elderly patients with colorectal cancer. Surg Laparosc Endosc Percutan Tech. 2014; 24:85–88.

25. Rosin D, Zmora O, Hoffman A, et al. Low incidence of adhesion-related bowel obstruction after laparoscopic colorectal surgery. J Laparoendosc Adv Surg Tech A. 2007; 17:604–607.

26. Kehlet H. Fast-track colorectal surgery. Lancet. 2008; 371:791–793.