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CHARACTERISTICS AND SHORT TERM OUTCOMES OF PATIENTS UNDERGOING MINIMALLY INVASIVE VERSUS OPEN COLORECTAL RESECTION IN OCTOGENARIANS
Erica Pettke*1, Abhinit Shah1, Vesna Cekic1, Daniel Feingold2, Tracey D. Arnell2, Nipa D. Gandhi1, Richard L. Whelan2
1Mount Sinai West, New York , NY; 2NewYork-Presbyterian/Columbia, New York, NY
INTRODUCTION: There is a relative paucity of data regarding patients (pts) 80 years of age and older (≥ 80 years) as regards to MIS colorectal resection The objective of this study was to compare early postoperative outcomes between patients ≥ 80 years who underwent a minimally invasive or open colorectal resection.
METHODS: Review of an IRB approved data bases from 2 institutions for pts undergoing elective colorectal resections (CRR) from 2000-2015 was carried out. Operative notes, hospital and office charts were also reviewed. We compared preoperative (preop) comorbidities and 30 day postoperative (postop) complication rates between MIS and open CRR for pts ≥ 80 years old. The Students T and Chi-Square tests were used.
RESULTS: A total of 259 patients (pts) ≥ 80 years underwent CRR (Lap. Assisted (LA), 160 (61.9%). Hand-assist (HAL) 39 (15.1%); Open 60 (23%). Indications for surgery were: cancer, MIS 81.4%, Open 65%; diverticulitis, MIS 8%, Open 8%; benign neoplasm/other, MIS, 10.6%, Open, 26.7%. There were no differences in preop co-morbidities between the two groups but more males in the MIS group (p=0.02). As regards resection type, the MIS and open groups were similar except for a lower rate of right colectomy as well as a higher rate of sigmoidectomy and APR in the Open group. The diversion rate for the open and converted groups was 24% (vs 10% for MIS, p=0.03). The open conversion rate for both LA and HAL’s groups was 18%; the mean incision length for converted pts was 12.3 cm (vs 16.8 cm for Open pts) and the mean LOS 13.3 days (vs 15.5 days, Open; p=ns). Postop, pts undergoing MIS CRR had earlier return of bowel function (first flatus 3.0 vs 4.1 days, p <0.001, days to BM 3.4 vs 4.6, p <0.001) and shorter LOS (7.1 vs 15.5, p < 0.001) compared to pts undergoing open resection MIS CRR pts had a lower rate of postop blood transfusions (30% vs 53.3%, p <0.001), atrial fibrillation (3.5% vs 16.7%, p 0.0003), pneumonia (2.5% vs 10%, p 0.001), ileus (17.0% vs 25%, p 0.02), C. Difficile infection (1.5% vs 6.7%, p 0.005), anastomotic leak (1.0% vs 8.3%, p 0.04), septic shock (0.6% vs 5.4%, p 0.01), prolonged intubation (4.5% vs 13.3%, p 0.04), and reoperations (4.5% vs 15.0%, p 0.005).
CONCLUSION: While the preop co-morbidities were the same between MIS and open pts, those undergoing open CRR are assumed to have had more severe disease and more difficult operations (higher diversion, transfusion, intubation rates); also, the outcome differences between groups are too great to be attributed to the surgical methods alone. Conversion rates were high, however, converted MIS pts had short term outcomes the same as or slightly better than the open group and similar morbidity rates. This study demonstrates that most octogenarians benefit from MIS methods and that it is reasonable to offer an MIS procedure to pts ≥ 80 years.
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