Advanced Age – Indication or Contraindication for Laparoscopic Colorectal Surgery?

Czech version

Authors: I. Guňka; J. Dostalík; L. Martínek; P. Guňková; M. Mazur; P. Vávra
Authors‘ workplace: Chirurgická klinika, Fakultní nemocnice Ostrava, přednosta: doc. MUDr. Jan Dostalík, CSc.
Published in: Rozhl. Chir., 2010, roč. 89, č. 10, s. 628-633.
Category: Monothematic special - Original

Overview

Aim:
The aim of this study was to evaluate the results of laparoscopically-assisted (LAC) and open (OC) colorectal surgery in elderly patients (≥ 75 years) and to compare them to a cohort of younger patients (< 75 years) undergoing similar surgical procedures.

Methods:
Patients who underwent elective laparoscopically-assisted or open colorectal surgery in the period between January 2001 and December 2009 were included in the analysis. The primary end point was the incidence of short-term postoperative morbidity and mortality, long-term overall and colorectal cancer specific survival which were analyzed in relation to the age and operative technique.

Results:
During the study period, 557 elective laparoscopic and 404 elective open colorectal operations were performed. 190 patients (20 %) were older than 75 years, 99 of which underwent laparoscopic and 91 open surgery. In geriatric patients, the open approach was associated with increase of postoperative morbidity, statistically nonsignificant (LAC ≥ 75 years 30% vs. OC ≥ 75 years 40%, p = 0,151). In the laparoscopic procedures, the morbidity rate did not differ in both age groups (LAC ≥ 75 years 30% vs. LAC < 75 years 28%, p = 0,702). Conversely open procedures in elderly patients were associated with a significant increase of postoperative complications compared to younger patients (OC ≥ 75 years 40% vs. OC < 75 years 29%, p= 0,033). There was no difference in postoperative mortality rate between laparoscopic and open approach in geriatric patients (LAC ≥ 75 years 5% vs. OC ≥ 75 years 3%, p=0,548). Mortality rate did not differ in both age groups operated laparoscopically (LAC ≥ 75 years 5% vs. LAC < 75 years 3%, p = 0,322) even by open approach (OC ≥ 75 years 3% vs. OC < 75 years 2%, p = 0,433). Although five year overall survival was significantly lower in the older age group (LAC ≥ 75 years 43 ± 8% vs. LAC < 75 years 58 ± 4 %, p = 0,049; OC ≥ 75 years 35 ± 7% vs. OC < 75 years 56 ± 4%, p = 0,006), five year colorectal cancer specific survival was not different between both age groups (LAC ≥ 75 years 76 ± 9% vs. LAC < 75 years 75 ± 4%, p = 0,693; OC ≥ 75 years 67 ± 7% vs. OC < 75 years 69 ± 4%, p = 0,824). In the elderly patients surgical technique did not influenced overall five year survival (LAC ≥ 75 years 43 ± 8% vs. OC ≥ 75 years 35 ± 7%, p = 0,428), even five year colorectal cancer specific survival (LAC ≥ 75 years 76 ± 9% vs. OC ≥ 75 years 69 ± 7%, p = 0,393).

Conclusion:
Laparoscopically-assisted colorectal surgery should be particularly considered in geriatric patients, for the reason of lower incidence of postoperative complications. Oncological safety of miniinvasive approach in the treatment of colorectal cancer is valid also for the specific group of elderly patients.

Key words:
laparoscopy – colorectal surgery – age – morbidity – survival

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