Laparoscopic Surgery Reduces Risk of Postoperative Complications and Non Cancer-related Survival in Patients Over 80 Years Old With Colorectal Cancer

Abstract

Background: The short- and long-term results from several reports suggest that laparoscopic surgery (LAP) for elderly patients is expected to reduce the risk of complications due to its minimal invasiveness, However, little is known about the effect of LAP on long-term prognosis aside from cancer. Patients and Methods: Eighty-five cases over 80 years old with colorectal cancer whose primary lesions were resected consecutively were enrolled. Risk factors for complications were searched using categorized clinicopathological factors. The factors for death unrelated to cancer were analyzed in patients by excluding cancer-related death. Results: Incidence of all complications, those of Clavien–Dindo grade 2 or more, and surgical site infection were significantly lower in LAP-treated patients (p=0.0343, p=0.0015 and p=0.0015, respectively). By multivariate analysis, LAP (odds ratio=0.19, 95% confidence intervaI=0.05-0.75, p=0.0177) and no pulmonary dysfunction (odds ratio=0.24, 95% confidence intervaI=0.06-0.96, p=0.0441) were significantly associated with reduced risk of complications of Clavien–Dindo grade 2 or more. LAP, no pulmonary dysfunction and Eastern Cooperative Oncology Group performance status of 0 or 1 were also significantly associated with reduced risk for death from non cancer-related causes. Additionally, LAP was significantly associated with improved survival excluding cancer-related death in patients with pulmonary dysfunction (p=0.0020) or with poor performance status (p=0.0412). Conclusion: These results suggest that fewer complications and non cancer-related deaths were achieved in very elderly patients with colorectal cancer when treated by LAP.

Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer

“…Previous studies have revealed that laparoscopic surgery shows evident advantages over conventional open surgery with less surgical trauma, rapid recovery, and comparable survival outcomes, regardless of the age group. For elderly patients with colorectal cancer, laparoscopic surgery significantly reduced the postoperative complications and non-cancer-related death compared to open surgery [ 20 ]. A recent meta-analysis revealed that elderly patients derived apparent benefits from laparoscopic surgery, including less blood loss and shorten hospital stay, as well as equivalent long-term outcomes when compared with open surgery [ 8 ].…”

The efficacy and safety of pure laparoscopic liver resection for hepatocellular carcinoma in super‐elderly patients over 80 years: A multicenter propensity analysis

“…In recent years, reports on the safety and efficacy of laparoscopic gastrectomy and colorectomy in patients aged ≥80 years have begun to increase. [10][11][12][13] Several reports have shown the safety of LLR for HCC in elderly patients, with noninferiority or superiority of LLR's surgical outcomes in patients over 65 or 70 years of age. 7,[25][26][27][28] However, reports focusing on super-elderly patients aged ≥80 years are very rare.…”

“…Therefore, it is important to prove the safety and effectiveness of laparoscopic surgery in patients aged ≥80 years. In recent years, reports on the safety and efficacy of laparoscopic gastrectomy and colorectomy in patients aged ≥80 years have begun to increase 10–13 . Several reports have shown the safety of LLR for HCC in elderly patients, with noninferiority or superiority of LLR's surgical outcomes in patients over 65 or 70 years of age 7,25–28 .…”

“…[6][7][8][9] Especially in colorectal and gastric cancer, reports on the safety of laparoscopic surgery for super-elderly patients ≥80 years of age have begun to increase. [10][11][12][13] On the other hand, most reports on laparoscopic liver resection (LLR) for the elderly set the borderline for the elderly at 65 or 70 years of age, [14][15][16] and very few have focused on patients aged ≥80 years. Since liver resection is often performed using the controlled low central venous pressure (CVP) technique, it is very important to prove that LLR can be safely performed in super-elderly patients with reduced functional reserve without increasing complications such as organ failure.…”

“…Recently, several reports have shown the safety and efficacy of laparoscopic surgery for the elderly in various surgeries, not only liver surgery 6–9 . Especially in colorectal and gastric cancer, reports on the safety of laparoscopic surgery for super‐elderly patients ≥80 years of age have begun to increase 10–13 . On the other hand, most reports on laparoscopic liver resection (LLR) for the elderly set the borderline for the elderly at 65 or 70 years of age, 14–16 and very few have focused on patients aged ≥80 years.…”