Short-term outcomes of laparoscopic surgery in octogenarians with colorectal cancer: a single-institution analysis

Miguchi, Masashi; Yoshimitsu, Masanori; Hakoda, Keishi; Omori, Ichiro; Kohashi, Toshihiko; Hihara, Jun; Ohdan, Hideki; Hirabayashi, Naoki

doi:10.1007/s00595-017-1584-9

Cited by 12 publications

(13 citation statements)

References 39 publications

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“…Kochi et al [9] reported that restrictive respiratory impairment, obstructive respiratory impairment, history of cerebrovascular events and open surgery were determined to be risk factors of postoperative pneumonia in colorectal surgery for patients aged !80 years. Recently, many researchers have reported that short-term outcomes of laparoscopic colorectal surgery for their elderly patients were better than those of open surgery [11][12][13][14]. Niitsu et al [13] reported that laparoscopic surgery in elderly colorectal cancer patients with poor performance status was safe and not inferior to open surgery in terms of overall survival.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Colorectal Cancer Surgery for ≥ 85-year-old Patients in Our Hospital: Retrospective Comparison of Short- and Long-term Outcomes with Younger Patients

Fukuoka

Makizumi

Asano

et al. 2021

J Anus Rectum Colon

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Objectives: To evaluate future problems in colorectal cancer surgery for elderly patients. Methods: We conducted a retrospective review of patients receiving colorectal cancer surgery in our hospital from January 2010 to December 2018. Patients were divided into the !85-year-old patient group and the younger patient group. We compared patient backgrounds, surgical outcomes (surgical procedure, reduction of lymph node dissection range, operative duration, and blood loss), postoperative short-term outcomes (mortality, morbidity, and postoperative length of stay) and prognosis. Results: We performed colorectal cancer surgery on 1,240 patients during the study period. Of them, 109 (8.7%) were !85 years old, and 1,131 (91.2%) were < 85 years old. The American Society of Anesthesiologists physical status (ASA-PS) was significantly poorer in the elderly group than in the younger group and patients with a history of cardiac disease and anticoagulant use were significantly more in the elderly group. The rate of reduction of lymph node dissection range was significantly higher in the elderly group (16.8% vs. 3.8%, p < 0.05). Overall morbidity was significantly higher in the elderly group (42.2% vs. 21.9%, p < 0.05), as were the respective frequencies of pneumonia and thromboembolism (8.2% vs. 0.7%, p < 0.05 and 3.6% vs. 0.8%, p < 0.05, respectively). Postoperative hospital stay was significantly longer in the elderly group (17 vs. 12 days, p < 0.05). Overall survival was significantly lower in the elderly group (p < 0.05), but relapse-free survival and colorectal cancer-specific survival were not statistically different between the groups (p = 0.05 and p = 0.15, respectively). Conclusions: Prevention of postoperative pneumonia and thromboembolism remains a problem. After proper assessment and careful management of peri-operative surgical risks, surgery can be indicated in elderly patients.

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Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Colorectal Cancer Surgery for ≥ 85-year-old Patients in Our Hospital: Retrospective Comparison of Short- and Long-term Outcomes with Younger Patients

Fukuoka

Makizumi

Asano

et al. 2021

J Anus Rectum Colon

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“…Compared to OH, LH is more effective in terms of its impact on hospital stay, blood loss, and the complication rate (13)(14)(15). In colorectal cancer (16) and endometrial cancer (17) surgery, laparoscopic surgery also has the advantage of reducing blood loss. However, the laparoscopic surgical approach is more challenging; thus, few studies have elaborated on the independent impact it has on blood loss and the short- (8) and long-term outcomes of patients undergoing LH for HCC.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic hepatectomy for hepatocellular carcinoma: short- and long-term outcomes with blood loss

Lv¹,

Zhang²,

Yu³

et al. 2021

Transl Cancer Res TCR

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Background: Laparoscopic hepatectomy (LH) for treating hepatocellular carcinoma (HCC) is a complex procedure. Compared to open hepatectomy (OH), LH offers certain advantages such as faster recovery, smaller incisions, and shorter hospital stay, but bleeding during LH remains a significant concern. Currently, the impacts of blood loss on the short-and long outcomes of patients undergoing LH are poorly understood. This retrospective study analyzes the impacts of blood loss on the prognosis of LH in HCC patients.Methods: Between 2001 and 2019, 192 patients underwent LH for HCC at a single high-volume center.These patients were divided into two groups according to intraoperative blood loss (IBL) (Group A: ≤250 mL; Group B: >250 mL). The patient characteristics assessed included age, gender, cirrhosis, hepatitis B virus (HBV) infection, Child-Pugh class, number of tumors, tumor size, vascular invasion, and diabetes mellitus.The perioperative and postoperative factors compared included operative time, blood loss, type of resection, blood transfusion, general complications, surgical complications, hospital mortality, and postoperative hospital stay.Results: Factors associated with IBL in our multivariate analysis included the type of resection (P<0.01) and operative time (P<0.01). IBL, tumor size and number of tumors were independent predictors of a patient's overall survival (OS) and recurrence-free survival (RFS). Through our subgroup multivariate analysis, we found that IBL was the only significant factor associated with RFS (P<0.02). There was also a noted IBL "dose effect", as patients with IBL >1,000 mL had a worse median OS (24 months) and median RFS (6 months), while patients with IBL 250-1,000 mL had a median OS of 36 months and RFS of 12 months, and patients with IBL ≤250 mL had a median OS of 36 months and RFS of 24 months. Conclusions:We found that the extent of IBL during LH was related to tumor size, operative time, and surgery type. Increased IBL during LH was also an independent prognostic factor for tumor recurrence.Furthermore, a dose-response relationship between increased IBL and decreased RFS and OS was evident.

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“…A total of 24 studies were considered for inclusion 31–54 . Table 1 presents the details of the studies included in the review.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic versus open surgery for elderly patients with colorectal cancer: a systematic review and meta‐analysis of matched studies

Luo

Chen

2022

ANZ Journal of Surgery

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Background To compare clinical and survival outcomes between laparoscopic versus open surgery in elderly colorectal cancer patients. Methods PubMed, Embase and Scopus databases were systematically searched. The review included studies that were either randomized controlled trials (RCTs) or observational in design. STATA was used for statistical analysis. Results The meta‐analysis was conducted with 24 studies. Compared with elderly subjects with open surgery, those undergoing laparoscopic surgery had a lower risk of mortality (within 3 months postoperatively) (RR 0.70, 95% CI: 0.53, 0.94). The long‐term overall survival (HR 0.96, 95% CI: 0.89, 1.04), disease‐free survival (HR 1.02, 95% CI: 0.93, 1.13), risk of recurrence (RR 1.44, 95% CI: 0.90, 2.30) and readmission (RR 1.11, 95% CI: 0.88, 1.40) rates were statistically similar in both the groups. The operative time (in minutes) was higher (WMD 30.37, 95% CI: 17.75, 43.0) and the blood loss (in ml) was lower (WMD −78.85, 95% CI: −101.96, −55.75) in those undergoing laparoscopic surgery. The length of hospital stay (in days) (WMD −2.53, 95% CI: −3.11, −1.95) and the time of return of bowel movements (in days) (WMD −1.06, 95% CI: −1.20, −0.93) was lower in those with laparoscopic surgery. The pooled risk of complications was lower in those with laparoscopic surgery (RR 0.66, 95% CI: 0.60, 0.74), compared with open surgery. Conclusions Findings suggest that in elderly subjects with colorectal cancer, laparoscopic surgery appears to be more beneficial than open surgery and should be prioritized, subject to the availability of required technical skills and facilities.

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Short-term outcomes of laparoscopic surgery in octogenarians with colorectal cancer: a single-institution analysis

Abstract: Laparoscopic surgery in octogenarians with CRC is a safe, low-invasive alternative to open surgery with less blood loss and a shorter hospital stay.

Cited by 12 publications

References 39 publications

Surgical Outcomes of Colorectal Cancer Surgery for ≥ 85-year-old Patients in Our Hospital: Retrospective Comparison of Short- and Long-term Outcomes with Younger Patients

Surgical Outcomes of Colorectal Cancer Surgery for ≥ 85-year-old Patients in Our Hospital: Retrospective Comparison of Short- and Long-term Outcomes with Younger Patients

Laparoscopic hepatectomy for hepatocellular carcinoma: short- and long-term outcomes with blood loss

Laparoscopic versus open surgery for elderly patients with colorectal cancer: a systematic review and meta‐analysis of matched studies

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