The number of operations on elderly colorectal cancer (CRC) patients has increased with the aging of the population. The aim of this study was to evaluate surgical outcomes in elderly patients who underwent laparoscopic or open surgery for CRC. We analyzed the data of 280 patients aged 80 or over who underwent surgery for CRC between January 2001 and December 2010. Seventy‐one pairs were selected after propensity score matching for laparoscopic or open surgery. Operative time, return to normal bowel function, length of hospital stay, postoperative complications, overall survival (OS), recurrence‐free survival (RFS), and prognostic factors affecting survival were investigated. In matched cohorts, operative time in the laparoscopic group was longer than in the open group (P < 0.001). In the laparoscopic group, time to flatus passage (P < 0.001) and length of postoperative hospital stay (P = 0.037) were shorter than in the open group. The rate of operation‐related morbidity was higher in the open group (P = 0.019). There was no difference in OS and RFS between two groups. This study suggests that laparoscopic surgery for CRC in elderly patients may be safe and feasible, with better short‐term outcomes. OS and RFS, however, were not different in both groups.

AIMTo identify the factors influencing cecal insertion time (CIT) and to evaluate the effect of obesity indices on CIT.METHODSWe retrospectively reviewed the data for participants who received both colonoscopy and abdominal computed tomography (CT) from February 2008 to May 2008 as part of a comprehensive health screening program. Age, gender, obesity indices [body mass index (BMI), waist-to-hip circumference ratio (WHR), waist circumference (WC), visceral adipose tissue (VAT) volume and subcutaneous adipose tissue (SAT) volume on abdominal CT], history of prior abdominal surgery, constipation, experience of the colonoscopist, quality of bowel preparation, diverticulosis and time required to reach the cecum were analyzed. CIT was categorized as longer than 10 min (prolonged CIT) and shorter than or equal to 10 min, and then the factors that required a CIT longer than 10 min were examined.RESULTSA total of 1678 participants were enrolled. The mean age was 50.42 ± 9.931 years and 60.3% were men. The mean BMI, WHR, WC, VAT volume and SAT volume were 23.92 ± 2.964 kg/m2, 0.90 ± 0.076, 86.95 ± 8.030 cm, 905.29 ± 475.220 cm3 and 1707.72 ± 576.550 cm3, respectively. The number of patients who underwent abdominal surgery was 268 (16.0%). Colonoscopy was performed by an attending physician alone in 61.9% of cases and with the involvement of a fellow in 38.1% of cases. The median CIT was 7 min (range 2-56 min, IQR 5-10 min), and mean CIT was 8.58 ± 5.291 min. Being female, BMI, VAT volume and involvement of fellow were significantly associated with a prolonged CIT in univariable analysis. In multivariable analysis, being female (OR = 1.29, P = 0.047), lower BMI (< 23 kg/m2) (OR = 1.62, P = 0.004) or higher BMI (≥ 25 kg/m2) (OR = 1.80, P < 0.001), low VAT volume (< 500 cm3) (OR = 1.50, P = 0.013) and fellow involvement (OR = 1.73, P < 0.001) were significant predictors of prolonged CIT. In subgroup analyses for gender, lower BMI or higher BMI and fellow involvement were predictors for prolonged CIT in both genders. However, low VAT volume was associated with prolonged CIT in only women (OR = 1.54, P = 0.034).CONCLUSIONBeing female, having a lower or higher BMI than the normal range, a low VAT volume, and fellow involvement were predictors of a longer CIT.

Purpose: Robotic systems (the da Vinci Surgical System) may offer considerable advantages, particularly in rectal surgery operated in the confined pelvis. This study was carried out on the assumption that a robotically naive, yet laparoscopically experienced surgeon successfully transferred to a robotic environment. We assessed immediate surgical outcomes of robotic intersphincteric resection (ISR) as an initial experience of a single surgeon. Methods: We analyzed the data of 19 consecutive patients with rectal cancer who underwent robot ISR between January 2009 and March 2012. Its immediate surgical outcomes were compared with those of 19 patients who underwent laparoscopic ISR as a control group of the same cohort. Results: There was no significant difference in the mean operating time between robotic and laparoscopic group (261.6 ± 57.7 minutes, 222.37± 68.2 minutes, P= 0.064). Mean distal resection margin was 1.5± 2.2 and 1.1± 0.9 in robotic and laparoscopic groups, respectively (P= 0.464). Three patients in each group had a circumferential margin clearance of less than 1 mm. Two patients in each group suffered from anastomotic leakeage. There were no significant differences in date of flatus passage and dietary intake, and the length of postoperative hospital stay between both groups. Conclusion: Robotic ISR is a safe and feasible procedure and its early short-term surgical outcomes are comparable to those of laparoscopic surgery.