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SHORT-TERM OUTCOMES OF LAPAROSCOPIC COLORECTAL SURGERY IN ELDERLY PATIENTS.-IS IT REALLY SAFE IN ELDERLY PATIENTS?
Koetsu Inoue*, Tatsuya Ueno, Orie Suzuki, Daisuke Douchi, Kentaro Shima, Shinji Goto, Michinaga Takahashi, Hiroo Naitoh
Surgery, South Miyagi Medical Center, Miyagi, Japan
Background
As the population age becomes higher, laparoscopic colorectal surgery (LCS) is applied to elderly patients as well as young patients. Since laparoscopic surgery is reported to affect respiration and circulation, we should take indication of LCS for elderly patients into consideration carefully. Indication of LCS for elderly patients, however, is still controversial. The aim of this study is to assess the safety and validity of LCS for elderly patients.
Method
Medical records were retrospectively reviewed for 493 patients who underwent either laparoscopic or open operation for colorectal cancer between 2010 and 2016. Forty-eight patients were excluded for following reasons (ex. double colorectal cancer, colorectal cancer with other gastrointestinal cancer, emergency operation for obstruction caused by colorectal cancer, total pelvic exenteration, total proctocolectomy for colon cancer accompanied by familial adenomatous polyposis). 445 patients were divided into four groups according to age and procedure; Group A (n=33): Age ≥80 and LCS, Group B (n=140): Age <80 and LCS, Group C (n=89): Age ≥80 and open colorectal surgery (OCS), Group D (n=183): Age <80 and OCS. Patients in Group A were compared with Group B, Group C and Group D. Preoperative characteristics and postoperative outcomes were analyzed. Statistical analysis was performed by Dunnett’s test and/or Pearson’s chi-square test.
Results
The mean age in Group A, B, C and D was shown in Table 1. The male / female ratio of Group A was significantly lower than Group B (A vs B: p=0.021). BMI did not reach significant difference between the groups. Rate of patients with The American Society of Anesthesiologists (ASA) grade≥3 did not differ between the groups. In Group A, rate of patients with Performance Status≥3 was greater than in Group B (A vs B: p=0.001). The operative procedures were shown in Table 2. Rate of low anterior resection, which is usually considered to develop more complications, did not differ in this analysis. Although operating time was similar in these groups, blood loss was significantly greater in Group C compared with Group A (A vs C: p=0.015). The number of lymph nodes harvested did not differ in the groups. The rate of postoperative complications with grade of Clavien-Dindo classification≥3 was greater in Group B than in Group A (A vs B: p=0.049). Especially, respiratory and cardiovascular complication was not observed in Group A. Postoperative hospital stay did not show any significant difference.
Conclusion
In LCS for elderly patients, incidence of severe postoperative complication was not high when compared with elderly patients of OCS and non-elderly patients of LCS. In addition, respiratory and cardiovascular complication was not observed in elderly patients of LCS. Therefore, LCS can be performed safely even in elderly patients.
Table 1
| | Group A (n=33) | Group B (n=140) | Group C (n=89) | Group D (n=183) | | Patients characteristics | | | | | | Age, years (mean±SEM) | 83.3±1.33 | 65.3±0.65 | 84.4±0.81 | 67.3±0.57 | | Male sex, no. patients (%) | 11 (33.3) | 78 (55.7) | 39 (43.8) | 113 (61.8) | | BMI, kg/m2 (mean±SEM) | 22.3±0.70 | 24.0±0.34 | 22.1±0.43 | 22.4±0.30 | | PS: 3 and more, no. patients (%) | 5 (15.2) | 3 (2.1) | 18 (20.2) | 10 (5.5) | | ASA-PS: 3 and more, no. patients (%) | 6 (18.2) | 22 (15.7) | 32 (36.0) | 37 (20.2) | | Surgical findings | | | | | | Operating time, min (mean±SEM) | 224±12.2 | 250±5.9 | 185±7.4 | 231±5.2 | | Blood loss, ml (mean±SEM) | 40.1±66.3 | 52.7±32.2 | 251±40.4 | 463±28.1 | | Number of harvested lymph nodes (mean±SEM) | 18.4±2.2 | 18.0±1.1 | 21.6±1.4 | 23.7±0.95 | | Postoperative outcomes | | | | | | C-D classification: Grade â…¢a and more | 0 (0) | 15 (10.7) | 7 (7.9) | 18 (9.8) | | Postoperative hospital stay, days (mean±SEM) | 12.3±2.4 | 14.1±1.2 | 18.4±1.5 | 18.6±1.0 |
BMI: Body Mass Index,PS: Performance Status, ASA-PS: American Society of Anesthesiologists-Physical Status, C-D classification: Clavien -Dindo classification Table 2 | | Group A (n=33) | Group B (n=140) | Group C (n=89) | Group D (n=183) | | Operative procedures | | | | | | Right colectomy/ Ileocecal resection, no. patients (%) | 14 (42.4) | 35 (25.0) | 53 (59.6) | 55 (30.1) | | Transverse colectomy, no. patients (%) | 3 (9.1) | 5 (3.6) | 8 (9.0) | 6 (3.3) | | Left colectomy, no. patients (%) | 1 (3.0) | 8 (5.7) | 3 (3.4) | 8 (4.4) | | Sigmoidectomy, no. patients (%) | 3 (9.1) | 22 (15.7) | 12 (13.5) | 17 (9.3) | | High anterior resection, no. patients (%) | 6 (18.2) | 33 (23.6) | 8 (9.0) | 40 (21.9) | | Low anterior resection, no. patients (%) | 3 (9.1) | 28 (20.0) | 3 (3.4) | 24 (13.1) | | Hartmann operation/Miles' operation, no. patients (%) | 3 (9.1) | 9 (6.4) | 3 (3.4) | 34 (18.6) |
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