Advantages of Laparoscopic Colectomy in Older Patients

Abstract

Hypothesis: Few data describe the relative benefits of an expedited recovery program and laparoscopic technique in older vs younger patients undergoing colectomy. We compared short-term outcomes in age-matched cohorts of patients undergoing laparoscopic vs open segmental colectomy managed with the Controlled Rehabilitation With Early Ambulation and Diet program. Design: Four age-matched cohorts of patients were compared: (1) patients 70 years or older undergoing laparoscopic colectomy (group 1), (2) those 70 or older undergoing open colectomy (group 2), (3) those younger than 60 undergoing laparoscopic colectomy (group 3), and (4) those younger than 60 undergoing open colectomy (group 4). Methods: Data collected included age, sex, body mass index, Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, American Society of Anesthesiologists' score, estimated blood loss, operative duration in minutes, pathologic findings, type of segmental colectomy, complications, mortality, length of hospital stay, and 30-day readmission rate. Results: Four hundred seventy-six patients fulfilled the inclusion criteria and had complete data available for collection (group 1, 50 patients; group 2, 123 patients; group 3, 181 patients; and group 4, 122 patients). Demographic data, operative procedures, and pathologic findings were similar among the cohorts. The mean±SEM length of hospital stay was significantly shorter with laparoscopic surgery in both age cohorts (group 1, 4.2±3.0 days; group 2, 9.3±7.6 days; group 3, 3.9±5.9 days; and group 4, 6.1±3.0 days). The mean±SEM direct hospital costs were significantly lower only with laparoscopic colectomy in the older cohorts. Using the Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, it was noted that group 2 experienced an observed rate of morbidity similar to that predicted. Conversely, groups 1, 3, and 4 had rates that were significantly lower than expected. Mean±SEM readmission rates were comparable in the older cohorts (group 1, 6.0%, and group 2, 6.5%) but significantly different in the younger cohorts (group 3, 9.4%, and group 4, 4.1%). Conclusions: The Controlled Rehabilitation With Early Ambulation and Diet program in combination with laparoscopic segmental colectomy can be safely performed in all age groups. The technique offers particular advantages to older patients because of reductions in length of hospital stay, morbidity and mortality rates, and direct cost of care.

Short-term outcomes between laparoscopy-assisted and open colorectomy for colorectal cancer in elderly patients: A case-matched control study

“…These results are similar to those reported by previous studies, as the operative time of the laparoscopic procedure was reported to be 20-30 min longer compared to laparotomy (9)(10)(11)(12). Only in the study by Senagore et al was the operative time reported to be shorter with LC (14), but no further discussion was offered regarding this finding. Despite the longer operative time, less blood loss and lower transfusion rate demonstrated that LC is safe for elderly patients.…”

Clinical outcomes of the very elderly undergoing enhanced recovery programmes in elective colorectal surgery

“…This rate is comparable with published data. 24 There were no deaths in the VE group. Although three deaths occurred in the non-VE cohort, there was no statistical difference between the mortality rates.…”

“…A similar pattern has been described in the literature. 24 There was, however, no statistical difference in readmission rates between the two cohorts.…”

Long-term Results after Laparoscopic Resection for Colorectal Cancer within a Fast-track Regimen in the Elderly: A Prospective Study~!2009-10-21~!2010-01-27~!2010-04-22~!

“…Nevertheless, several studies as mentioned earlier have shown a beneficial short-term effect of laparoscopic colorectal cancer surgery in elderly people [1][2][3][4]. A recent paper dealing with redefining contraindications to laparoscopic colorectal resection for high-risk patients has concluded that in experienced hands, laparoscopic colorectal surgery can be performed safely for these patients and argued against using parameters of increased age, morbid obesity, high ASA class, or preoperative radiation alone as contraindications to even complex laparoscopic colorectal procedures [19].…”

“…The beneficial short-term effect of laparoscopic colorectal cancer surgery in elderly people with regard to reductions in length of hospital stay, morbidity and mortality rates is shown in several studies [1][2][3][4]. A recent Cochrane analysis of long-term results of laparoscopic colorectal cancer resection concluded that laparoscopic surgery for colon cancer is a safe procedure with a survival rate equal to survival after open surgery, but trials that also include elderly patients with co-morbidity are needed [5].…”