Minimally Invasive Compared to Open Colorectal Cancer Resection for Older Adults

Abstract

Cancer (RESTORE-Cancer) groupObjective: We sought to compare long-term healthcare dependency and time-at-home between older adults undergoing minimally invasive surgery (MIS) for colorectal cancer (CRC) and those undergoing open resection. Background: Although the benefits of MIS for CRC resection are established, data specific to older adults are lacking. Long-term functional outcomes, central to decision-making in the care for older adults, are unknown. Methods: We performed a population-based analysis of patients ≥70years old undergoing CRC resection between 2007 to 2017 using administrative datasets. Outcomes were receipt of homecare and "high" time-at-home, which we defined as years with ≤14 institution-days, in the 5years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High timeat-home was assessed using Cox multivariable models. Results: Of 16,479 included patients with median follow-up of 4.3 (interquartile range 2.1-7.1) years, 7822 had MIS (47.5%). The MIS group had lower homecare use than the open group with 22.3% versus 31.6% at 6 months and 14.8% versus 19.4% at 1 year [hazard ratio 0.87,95% confidence interval (CI) 0.83-0.92]. The MIS group had higher probability ofhigh time-at-home than open surgery with 54.9% (95% CI 53.6%-56.1%) versus 41.2% (95% CI 40.1%-42.3%) at 5years (hazard ratio 0.71, 95% CI 0.68-0.75). Conclusions:Compared to open surgery, MIS for CRC resection was associated with lower homecare needs and higher probability of high time-at-home in the 5 years after surgery, indicating reduced long-term functional dependence. These are important patient-centered endpoints reflecting the overall long-term treatment burden to be taken into consideration in decision-making.

What are the short‐ and long‐term abdominal consequences of an omentectomy? A systematic review

“…Laparotomy was mainly used to harvest the omentum, this may have contributed to the substantial rate of incisional hernias 43,44 . Laparoscopic surgery is preferred in current practice and could reduce the incidence of developing postoperative hernia's, and shorter length of hospital stay, quicker return of bowel function, reduce postoperative pain and opiate use 45,46 . Next to this, the extra‐peritoneal route of the omental pedicle, most frequently by using a subcutaneous tunnel or through the diaphragm, contributes to the occurrence of postoperative (diaphragmatic) herniation.…”

“…43,44 Laparoscopic surgery is preferred in current practice and could reduce the incidence of developing postoperative hernia's, and shorter length of hospital stay, quicker return of bowel function, reduce postoperative pain and opiate use. 45,46 Next to this, the extraperitoneal route of the omental pedicle, most frequently by using a harvested for extra-peritoneal reconstructive purposes. Second, comparative studies included very heterogeneous groups and investigated varying outcome measures, therefore a meta-analysis could not be performed.…”

Competitive Risk Analysis of Prognosis in Older Adults with Sigmoid Colon Adenocarcinoma: A Population-Based Study

“… 12 This nuanced approach to treatment highlights the importance of personalizing care based on age, comorbidities, and cancer-specific characteristics. 13 In addition, the advent of minimally invasive surgery (MIS) has provided encouraging outcomes for older adults, with reduced long-term functional dependence and a higher probability of staying at home postoperatively compared to patients undergoing open resection. 14 In conclusion, the risk factors and prognosis of sigmoid carcinoma vary widely between young and older adults, reflecting the need for tailored management strategies to optimize care across the lifespan.…”