Physiopathology and clinical considerations of laparoscopic surgery in the elderly

Caglià, Pietro; Tracia, Angelo; Buffone, A; Amodeo, Luca; Tracia, Luciano; Amodeo, C; Veroux, Massimiliano

doi:10.1016/j.ijsu.2016.05.044

Cited by 29 publications

(32 citation statements)

References 91 publications

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“…A recent meta-analysis [37] shows that laparoscopy is associated with an earlier return to home with a satisfactory quality of life. In our study, and according to the literature [37][38][39], it is worthwhile to note that most emergency interventions are laparoscopic. According to the research in [24,25], the use of supraglottic airway devices is also associated with a more rapid return to spontaneous breathing.…”

Section: Discussionmentioning

confidence: 77%

Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients

et al. 2021

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Background: the general population is aging across the world. Therefore, even surgical interventions in the elderly—in particular those involving emergency surgical admissions—are becoming more frequent. The elderly population is often frail (in multiple physiological systems, this is often defined as age-related cumulative decline). This study involved a 2-year follow-up evaluation of frail elderly patients treated with urgent surgical intervention at Santa Maria Regina della Misericordia Hospital, General Surgery Department, in Adria (Italy). Method: a prospective, single-center, 2-year follow-up study of 120 patients >65 years old, treated at our department for surgical abdominal emergencies. We considered co-morbidities (ASA—American Society of Anesthesiologists Physical Status Classification System—score), type of surgery (laparoscopy, laparotomy or converted), frailty score, mortality, and complications at 30 days and at 2 years. Conclusions: 70 (58.4%) patients had laparoscopy, 49 (40.8) had laparotomy, and in 1 (0.8%) case, surgery was converted from laparoscopy to laparotomy. Mortality strictly depends on the type of surgery (laparotomy vs. laparoscopy), complications during recovery, and a lower Fried frailty criteria score, on average. The long-term follow-up can be a useful tool to highlight a safer surgical approach, such as laparoscopy, in frail elderly patients. We consider the laparoscopic approach feasible in emergency situations, with similar or better outcomes than laparotomy, especially in frail elderly patients.

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Section: Discussionmentioning

confidence: 77%

Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients

et al. 2021

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“…Demographic estimates show that the human population aged 65 years or older will exceed 1.5 billion in 2050 (10). Increasing life expectancies and improvements in medical technology and healthcare lead to an increase in the number of elder patients undergoing complex surgical procedures (11). Elderly patients have several physiologic changes such as cardiovascular, pulmonary and hepatorenal that impact their response to anaesthesia, surgical stress and postoperative rehabilitation (12).…”

Section: Discussionmentioning

confidence: 99%

“…In this context, laparoscopic approaches with benefits, including less postoperative pain or more rapid return to regular daily activities are well suited to the challenges of elderly individuals (13). On the other hand, the increased physiologic demands of laparoscopic approaches may present particular challenges on elderly patients (11). This situation may be more critical, especially in surgeries that hemodynamic parameters are affected, such as PHEO.…”

Section: Discussionmentioning

confidence: 99%

Is Laparoscopic Adrenalectomy for Pheochromocytoma a Safe and Effective Surgery in Geriatric Patients?

Gunseren

Çiçek

Bolat

et al. 2021

Preprint

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Objectives: In this study, we aimed to evaluate the haemodynamic changes of laparoscopic adrenalectomy (LA) in geriatric patients with pheochromocytoma (PHEO). To the best of our knowledge, it is the first study evaluating the haemodynamic outcomes of pure LA in this patient population. Methods: Between 2000-2020, data of 350 patients who underwent single-side transperitoneal LA were reviewed retrospectively. Patients with a histopathological diagnosis of PHEO were enrolled and classified into two groups according to their ages at the date of surgery. Older than 65 years were accepted as elderly according to the World Health Organisation recommendations. Results: Overall 54 patients underwent single side LA for PHEO. Fifteen patients were enrolled in the elderly group and 39 in the young group. There were no significant differences regarding the operation site (0.564) and tumour size (0.878). There were no statistically significant differences in terms of perioperative outcomes, such as mean anaesthesia and operation times, blood loss and haemodynamic changes. Regarding postoperative outcomes; there were no statistically significant differences in mean hospitalization and intensive care unit times. In 1 patient in each grade-1 (prolonged ileus, managed with medical treatment) and grade 2 complication (transfusion during surgery) observed in the elderly and young groups, respectively (p=0.498). Conclusion: Laparoscopic adrenalectomy in elderly patients with PHEO is as safe and effective as in younger patients. One of the most important conditions for achieving good perioperative and postoperative outcomes in the elderly patient population with this challenging surgery is the multidisciplinary approach.

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“…On the other hand, in the LCG group, the operation time tended to be longer in patients who had D2 lymph node dissection for gastric cancer as primary surgery. Especially for elderly patients, the physiopathological implications of laparoscopy including prolonged operation time should be carefully considered [21]. Therefore, LCG needs to be cautiously selected in patients who underwent D2 lymph node dissection for gastric cancer as primary surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic completion gastrectomy in elderly patients with remnant gastric cancer: a case series

Kaihara¹,

Matsuda

Booka³

et al. 2019

surg case rep

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Background Open completion gastrectomy (OCG) has been selected to treat remnant gastric cancer (RGC) due to severe adhesions and difficulty recognizing anatomical orientation after primary gastrectomy. In general, elderly individuals’ physiological reserves gradually decrease. Moreover, elderly patients (EPs) often have multiple complicating factors (i.e., frailty and comorbidities), leading to more postoperative complications after abdominal surgery. Recently, several trials revealed the advantages of laparoscopic surgery for EPs with gastric cancer in early recovery. However, there are limited studies investigating the use of laparoscopic completion gastrectomy (LCG) for RGC in EPs. This study aims to assess the efficacy of LCG in EPs aged ≥ 70 years. We compared the short- and long-term outcomes of LCG with those of OCG. Case presentation Twenty-one EPs who underwent completion gastrectomy for RGC between 2007 and 2017 were enrolled and classified into two groups according to the surgical approach, namely the LCG ( n = 6) and OCG ( n = 15) groups. We adopted the G8 geriatric screening tool to comprehensively evaluate the EPs’ physical, mental, and social functions. Patient characteristics, clinicopathological characteristics, surgical outcomes, and survival were retrospectively reviewed and compared between groups. Results There was no significant difference in the preoperative modified G8, indicating that the EPs’ backgrounds between the groups were comparable. Of note, blood loss during surgery was significantly reduced in the LCG group [median (range); LCG, 50 ml (20.0–65.0); OCG, 465 ml (264.5–714.0); p = 0.002]. The median number of retrieved lymph nodes in the LCG and OCG groups were 7 (range 4–10) versus 3 (range 1–6), respectively. There were no statistically significant differences in postoperative hospitalization, intake of solid food, and Clavien–Dindo grade ≥ II postoperative complications. In patients with a history of gastrectomy for gastric cancer in the LCG group, operative time tended to be longer in patients who underwent D2 lymph node dissection as primary surgery. Conclusions LCG was comparable to OCG for the treatment of RGC in EPs with significantly reduced blood loss. While LCG should be selected with caution in patients who have undergone D2 lymph node dissection as primary surgery, it could be considered as a surgical procedure in EPs with RGC.

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Physiopathology and clinical considerations of laparoscopic surgery in the elderly

Cited by 29 publications

References 91 publications

Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients

Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients

Is Laparoscopic Adrenalectomy for Pheochromocytoma a Safe and Effective Surgery in Geriatric Patients?

Laparoscopic completion gastrectomy in elderly patients with remnant gastric cancer: a case series

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