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Kryzauskas M, Bausys A, Kuliavas J, Bickaite K, Dulskas A, Poskus E, Bausys R, Strupas K, Poskus T. Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer. BMC Geriatr 2021; 21:682. [PMID: 34876049 PMCID: PMC8650566 DOI: 10.1186/s12877-021-02648-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The proportion of elderly colorectal cancer (CRC) patients requiring surgery is increasing. Colorectal resection for left-sided cancers is the most controversial as the primary anastomosis or end-colostomy and open or minimally invasive approaches are available. Therefore, this study was conducted to investigate the short- and long-term outcomes in elderly patients after resection with primary anastomosis for left-sided CRC. METHODS The cohort study included left-sided colorectal cancer patients who underwent resection with primary anastomosis. The participants were divided into non-elderly (≤75 years) and elderly (> 75 years) groups. Short- and long-term postoperative outcomes were investigated. RESULTS In total 738 (82%) and 162 (18%) patients were allocated to non-elderly and elderly groups, respectively. Minimally invasive surgery (MIS) was less prevalent in the elderly (42.6% vs 52.7%, p = 0.024) and a higher proportion of these suffered severe or lethal complications (15.4% vs 9.8%, p = 0.040). MIS decreased the odds for postoperative complications (OR: 0.41; 95% CI: 0.19-0.89, p = 0.038). The rate of anastomotic leakage was similar (8.5% vs 11.7%, p = 0.201), although, in the case of leakage 21.1% of elderly patients died within 90-days after surgery. Overall- and disease-free survival was impaired in the elderly. MIS increased the odds for long-term survival. CONCLUSIONS Elderly patients suffer more severe complications after resection with primary anastomosis for left-sided CRC. The risk of anastomotic leakage in the elderly and non-elderly is similar, although, leakages in the elderly seem to be associated with a higher 90-day mortality rate. Minimally invasive surgery is associated with decreased morbidity in the elderly.
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Affiliation(s)
- Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Augustinas Bausys
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre for Visceral Medicine and Translational Research, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Justas Kuliavas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Eligijus Poskus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rimantas Bausys
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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The Trends in Adoption, Outcomes, and Costs of Laparoscopic Surgery for Colorectal Cancer in the Elderly Population. J Gastrointest Surg 2021; 25:766-774. [PMID: 32424686 DOI: 10.1007/s11605-020-04517-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The elderly constitute the majority of both colorectal cancer and surgical volume. Despite established safety and feasibility, laparoscopy may remain underutilized for colorectal cancer resections in the elderly. With proven benefits, increasing laparoscopy in elderly colorectal cancer patients could substantially improve outcomes. Our goal was to evaluate utilization and outcomes for laparoscopic colorectal cancer surgery in the elderly. METHODS A national inpatient database was reviewed for elective inpatient resections for colorectal cancer from 2010 to 2015. Patients were stratified into elderly (≥ 65 years) and non-elderly cohorts (< 65 years), then grouped into open or laparoscopic procedures. The main outcomes were trends in utilization by approach and total costs, length of stay (LOS), readmission, and complications by approach in the elderly. Multivariable regression models were used to control for differences across platforms, adjusting for patient demographics, comorbidities, and hospital characteristics. RESULTS Laparoscopic adoption for colorectal cancer in the elderly increased gradually until 2013, then declined, with simultaneously increasing rates of open surgery. Laparoscopy significantly improved all primary outcomes compared to open surgery (all p < 0.01). From the adjusted analysis, laparoscopy reduced complications by 30%, length of stay by 1.99 days, and total costs by $3276/admission. Laparoscopic patients were 34% less likely to be readmitted; when readmitted, the episodes were less expensive when index procedure was laparoscopic. CONCLUSION The adoption of laparoscopy for colorectal cancer surgery in the elderly is slow and even declining recently. In addition to the clinical benefits, there are reduced overall costs, creating a tremendous value proposition if use can be expanded. PRECIS This national contemporary study shows the slow uptake and recent decline in adaption of laparoscopic surgery for colorectal cancer in the elderly, despite the benefits in clinical outcomes and costs found. This data can be used to target education, regionalization, and quality improvement efforts in this expanding population.
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Portale G, Valdegamberi A, Cavallin F, Frigo F, Fiscon V. Effect of Age and Comorbidities on Short- and Long-Term Results in Patients Undergoing Laparoscopic Curative Resection for Rectal Cancer. J Laparoendosc Adv Surg Tech A 2019; 29:353-359. [DOI: 10.1089/lap.2018.0340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, ULSS 6 Euganea, Cittadella, Italy
| | | | | | - Flavio Frigo
- Department of General Surgery, ULSS 6 Euganea, Cittadella, Italy
| | - Valentino Fiscon
- Department of General Surgery, ULSS 6 Euganea, Cittadella, Italy
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Clinical Outcomes of Single-port Surgery for Colon Cancer in Octogenarians. Surg Laparosc Endosc Percutan Tech 2018; 28:164-169. [PMID: 29672345 DOI: 10.1097/sle.0000000000000524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIM The aim of this study was to evaluate the clinical outcomes of single-port surgery for colon cancer in octogenarians. MATERIALS AND METHODS A retrospective cohort study was performed on patients who underwent single-port surgery for colon cancer from 2010 to 2014 at a single institution. Patients were categorized into the following 3 groups according to age: ≤69 years (n=196), 70 to 79 years (n=143), and ≥80 years (n=86). Short-term and long-term outcomes were assessed among 3 groups. RESULTS The rate of overall postoperative complications in the octogenarian group did not differ significantly, compared with the other groups (20.9% in the octogenarians group vs. 14.3% in the ≤69 y group and 15.4% in the 70 to 79 y group, P=0.363). The 3-year relapse-free survival rates were similar among groups (83.9% in the octogenarians group vs. 87.8% in the ≤69 y group and 87.5% in the 70 to 79 y group, P=0.754). The 5-year overall survival rates were 79.8% in the octogenarians group, 89.9% in the ≤69 years group, and 81.7% in the 70 to 79 years group (P=0.063). CONCLUSION Single-port surgery is safe, feasible, and can provide satisfactory oncological outcomes in octogenarians with colon cancer.
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Wei M, Zhang X, Ma P, He W, Bi L, Wang Z. Outcomes of open, laparoscopic, and hand-assisted laparoscopic surgeries in elderly patients with right colon cancers: A case-control study. Medicine (Baltimore) 2018; 97:e11907. [PMID: 30170384 PMCID: PMC6392753 DOI: 10.1097/md.0000000000011907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
An increasing proportion of patients aged more than 70 years old are suffering from colorectal cancers. This study aimed to compare the short- and long-terms outcomes between open surgery (OS) or conventional laparoscopic surgery (LS) and hand-assisted laparoscopic surgery (HALS) in treatment of these elderly patients with right colon cancers.We retrospectively reviewed patients who underwent right colon resections for cancers in our institution between June, 2009 and December, 2014. Short- and long-terms outcomes including surgical endpoints, postsurgical recovery data, postoperative morbidity and mortality, overall survival and disease-free survival were compared among OS, LS, and HALS groups. All data were analyzed by SPSS 22.0.Finally, 69 consecutive patients (OS = 26, LS = 24, HALS = 19) with right colon cancers were included in the analysis. Compared with OS, HALS was associated with less time to first anus exhaust (P = .013), first liquid diet (P = .045), and first soft diet (P = .036). Meanwhile, there were significant less operative time (P = .0027), blood loss (P < .001), and less time to first liquid diet (P = .009) in HALS, compared with LS. In regards to long-term outcomes, there were no significant differences in overall survival and disease-free survival among the 3 groups.Compared with OS or LS, HALS may be more favorable in the treatment of elderly right colon cancers with decreased surgical time and postoperative recovery, and comparable cancer-specific survivals.
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Affiliation(s)
- Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Pingfan Ma
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu
| | - Wanbin He
- The People's Hospital of Leshan, Leshan, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
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Fiscon V, Portale G, Migliorini G, Frigo F. Laparoscopic Resection of Colorectal Cancer in Elderly Patients. TUMORI JOURNAL 2018; 96:704-8. [DOI: 10.1177/030089161009600511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Aging of the population and a longer life expectancy have led to an increased number of elderly patients presenting with colorectal cancer and searching for treatment. The aim of the study was to assess the effects of age on the outcome of laparoscopic colorectal surgery for cancer at a single department. Methods Perioperative outcome of patients ≥75 years old undergoing laparoscopic colorectal surgery between June 2005 and January 2009 for colorectal cancer were compared with findings in younger patients. Results The analysis considered 134 patients <75 years and 82 patients ≥75 years of age. There was a significant difference in perioperative risk factors, as reflected by different ASA scores and a significantly higher postoperative ‘medical’ morbidity, but ‘surgical’ morbidity was similar in the two groups and remained low. Discussion Surgical morbidity rate was not affected by age. Cardiovascular and pulmonary comorbid conditions were mainly responsible for the higher morbidity rate reported in the elderly patients, although advanced age, per se, should not be considered a contraindication to laparoscopic colorectal surgery for cancer. Free full text available at www.tumorionline.it
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Affiliation(s)
- Valentino Fiscon
- Department of General Surgery, Azienda ULSS 15 ‘Alta Padovana’, Cittadella (Padova), Italy
| | - Giuseppe Portale
- Department of General Surgery, Azienda ULSS 15 ‘Alta Padovana’, Cittadella (Padova), Italy
| | - Giovanni Migliorini
- Department of General Surgery, Azienda ULSS 15 ‘Alta Padovana’, Cittadella (Padova), Italy
| | - Flavio Frigo
- Department of General Surgery, Azienda ULSS 15 ‘Alta Padovana’, Cittadella (Padova), Italy
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Venara A, Barbieux J, Mucci S, Talbot MF, Lermite E, Hamy A. Short-Term Outcomes of Colorectal Resection for Cancer in Elderly in the Era of Enhanced Recovery. Scand J Surg 2017; 107:31-37. [PMID: 28464708 DOI: 10.1177/1457496917706010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Early rehabilitation protocols should be assessed in elderly. We aimed to study the outcomes of colorectal surgery and the observance of the modalities of an early rehabilitation protocol in patients over 80 years. MATERIAL AND METHODS All consecutive patients who underwent surgery for colorectal cancer in our center over a 19-month period were included. All of these patients were managed using the same early rehabilitation protocol. Patients older than 80 were compared to younger patients. RESULTS A total of 173 patients were included and 36 were ≥80 years (20.8%). Patients aged ≥80 years had a significantly higher ASA score and were operated on in emergency. In the peroperative period, patients aged ≥80 years were more likely to undergo laparotomy than patients <80 years in univariate analysis (p = 0.048), but in multivariate analysis, the choice for a laparoscopy was influenced by ASA score ≤2 (odds ratio = 3.55, 95% confidence interval = 1.67-7.58) and emergency surgery (odds ratio = 0.18, 95% confidence interval = 0.06-0.50). In the postoperative period, peristalsis stimulation and vascular catheter ablation were significantly better followed in Group 1 (p = 0.012 and 0.031). However, in multivariate analysis, age was not significantly associated with these parameters. Peristalsis stimulation was influenced by ASA score ≥2 (odds ratio = 4.27, 95% confidence interval = 1.18-15.37) and vascular catheter ablation was also influenced by ASA score ≤2 (odds ratio = 2.63, 95% confidence interval = 1.33-5.21). Emergency surgery had a strong trend to influence these parameters (p = 0.08). CONCLUSION Although age or comorbidities may affect observance for certain modalities such as chewing gum use and vascular catheter ablation, an early rehabilitation protocol can be used after colorectal cancer surgery in patients ≥80 years old, where it would improve functional results and postoperative outcomes.
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Affiliation(s)
- A Venara
- 1 L'UNAM and University of Angers, Angers, France.,2 Department of Visceral Surgery, CHU Angers, Angers, France.,3 UMR INSERM 1235, TENS, the enteric nervous system in gut and brain disorder, University of Nantes, Nantes, France
| | - J Barbieux
- 1 L'UNAM and University of Angers, Angers, France.,2 Department of Visceral Surgery, CHU Angers, Angers, France
| | - S Mucci
- 1 L'UNAM and University of Angers, Angers, France
| | - M F Talbot
- 4 Department of Anesthesia and Intensive Care, CHU Angers, Angers, France
| | - E Lermite
- 1 L'UNAM and University of Angers, Angers, France.,2 Department of Visceral Surgery, CHU Angers, Angers, France
| | - A Hamy
- 1 L'UNAM and University of Angers, Angers, France.,2 Department of Visceral Surgery, CHU Angers, Angers, France
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Biondi A, Vacante M, Ambrosino I, Cristaldi E, Pietrapertosa G, Basile F. Role of surgery for colorectal cancer in the elderly. World J Gastrointest Surg 2016; 8:606-613. [PMID: 27721923 PMCID: PMC5037333 DOI: 10.4240/wjgs.v8.i9.606] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/15/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
The prevalence of subjects with colorectal cancer is expected to grow in the next future decades and surgery represents the most successful treatment modality for these patients. Anyway, currently elderly subjects undergo less elective surgical procedures than younger patients mainly due to the high rates of postoperative morbidity and mortality. Some authors suggest extensive surgery, including multistage procedures, as carried out in younger patients while others promote less aggressive surgery. In older patients, laparoscopic-assisted colectomy showed a number of advantages compared to conventional open surgery that include lower stress, higher rate of independency after surgery, quicker return to prior activities and a decrease in costs. The recent advances in chemotherapy and the introduction of new surgical procedures such as the endoluminal stenting, suggest the need for a revisitation of surgical practice patterns and the role of palliative surgery, mainly for patients with advanced disease. In this article, we discuss the current role of surgery for elderly patients with colorectal cancer.
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Wang M, Wei A, Zhang Z, Peng B. Laparoscopic Splenectomy for the Elderly Liver Cirrhotic Patients With Hypersplenism: A Retrospective Comparable Study. Medicine (Baltimore) 2016; 95:e3012. [PMID: 26962816 PMCID: PMC4998897 DOI: 10.1097/md.0000000000003012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A growing body of evidence has supported the benefits of laparoscopic splenectomy (LS) for hypersplenism due to liver cirrhosis. With the increased proportion of elderly persons worldwide, it is necessary to investigate the risks and benefits of LS in elderly liver cirrhotic patients.From September 2003 to March 2012, LS and open splenectomy (OS) were performed for 21 (Group 1) and 19 (Group 3) patients, respectively, all of whom were 65 years of age and older; in addition, 39 patients who were <65 years old were treated with LS and referred to as Group 2. Data (i.e., demographic characteristics and preoperative, intraoperative, and postoperative information) were retrospectively collected. Between-group comparisons were performed for the above-mentioned data.Compared with the patients in Group 3, the patients in Group 1 required longer operative times, fewer transfusions, less intensive care, a shorter postoperative course, and a shorter time to the first oral intake, and they had less blood loss and fewer postoperative short-term complications. During the follow-up period, compared with the preoperative status, significant changes in hemoglobin, leukocyte, platelet, and albumin levels were observed in all groups, whereas changes in the total BILirubin (BIL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were inconspicuous.Patients >65 years of age with hypersplenism caused by liver cirrhosis can safely undergo LS.
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Affiliation(s)
- Mingjun Wang
- From the Department of Pancreatic Surgery, West China Hospital, Guoxue Alley, Chengdu, Sichuan, China
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Roscio F, Boni L, Clerici F, Frattini P, Cassinotti E, Scandroglio I. Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case-control assessment. Surg Endosc 2016; 30:4372-82. [PMID: 26895891 DOI: 10.1007/s00464-016-4755-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/11/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND To evaluate the effectiveness of laparoscopic surgery (LCS) for colon and rectal cancer in the very elderly over 80 years old. METHODS We performed a prospective multicentric analysis comparing patients over 80 years (Group A) and patients between 60 and 69 years (Group B) undergoing LCS for cancer from January 2008 to December 2013. Colon and rectal cancers were analyzed separately. Comorbidity and complications were classified using the Charlson comorbidity index (CCI) and the Clavien-Dindo system, respectively. Oncological parameters included tumor-free margins, number of lymph nodes harvested and circumferential resection margin. RESULTS Group A included 96 and 33 patients, and Group B 220 and 82 for colon and rectal cancers, respectively. Groups were similar except for ASA score and CCI, as expected. There was no significant difference in operative time [colon; rectum] (180[IQR 150-200] vs 180[150-210] min; NS-180[160-210] vs 180[165-240] min; NS), estimated blood loss (50[25-75] vs 50[25-120] mL; NS-50[0-150] vs 50[25-108.7] mL; NS) and conversion rate (2.1 vs 2.7 %; NS-3.0 vs 2.4 %; NS). Timing of first stool (3[2-3.25] vs 3[2-5] dd; NS-3[2-4] vs 3[2-5] dd; NS), length of stay (7[6-8] vs 7[6-8] dd; NS-8[8-9] vs 8[7-9] dd; NS) and readmission rate (1.0 vs 0.45 %; NS-6.1 vs 1.2 %; NS) were similar. Tumor-free margins were appropriate, and positivity of CRM is poor (6.1 vs 4.9; NS). We did not record significant differences in complications rate (47.9 vs 43.6 %; NS-63.6 vs 52.4 %; NS). CONCLUSIONS Laparoscopic surgery is effective for the treatment of colorectal cancer even in the very elderly. Age is not a risk factor or a limitation for LCS.
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Affiliation(s)
- Francesco Roscio
- Division of General Surgery, Department of Surgery, Galmarini Hospital, Piazzale A. Zanaboni, 1, 21049, Tradate, Italy.
- PhD Program in Surgery and Surgical Biotechnologies, University of Insubria, Varese, Italy.
| | - Luigi Boni
- PhD Program in Surgery and Surgical Biotechnologies, University of Insubria, Varese, Italy
- Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy
| | - Federico Clerici
- Division of General Surgery, Department of Surgery, Galmarini Hospital, Piazzale A. Zanaboni, 1, 21049, Tradate, Italy
| | - Paolo Frattini
- Division of General Surgery, Department of Surgery, Galmarini Hospital, Piazzale A. Zanaboni, 1, 21049, Tradate, Italy
| | - Elisa Cassinotti
- Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy
| | - Ildo Scandroglio
- Division of General Surgery, Department of Surgery, Galmarini Hospital, Piazzale A. Zanaboni, 1, 21049, Tradate, Italy
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Okamura R, Hida K, Hasegawa S, Sakai Y, Hamada M, Yasui M, Hinoi T, Watanabe M. Impact of intraoperative blood loss on morbidity and survival after radical surgery for colorectal cancer patients aged 80 years or older. Int J Colorectal Dis 2016; 31:327-34. [PMID: 26412248 DOI: 10.1007/s00384-015-2405-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to assess the effect of intraoperative blood loss (IBL) on short- and long-term outcomes of colorectal cancer surgery for very elderly patients. METHODS We acquired the data of consecutive patients aged 80 years or older who underwent elective radical surgery for stage I to III colorectal cancer between January 2003 and December 2007 in 41 institutions. The patients were divided into high and low IBL groups, and the differences in postoperative morbidity and survival between the two groups were primarily assessed. Eleven factors were treated as potential confounders in multivariate analyses. RESULTS A total of 1554 patients were eligible for this study, with an age range of 80-103 years. Median IBL was 71 ml (interquartile range, 25 to 200 ml), and 412 patients had IBL ≥200 ml. Morbidity was 46% among patients with IBL ≥200 ml, compared with 30 % among those with IBL <200 ml (p < 0.001). Patients with IBL ≥200 ml had worse overall survival rates and recurrence-free survival rates at 1, 3, and 5 years than those with IBL <200 ml. In multivariate analyses, IBL ≥200 ml was identified as an independent risk factor for postoperative adverse events (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.08 to 1.86), overall survival (hazard ratio (HR) 1.34, 95% CI 1.04 to 1.72), and recurrence-free survival (HR 1.29, 95% CI 1.03 to 1.62). CONCLUSION The degree of IBL is significantly associated with postoperative morbidity and survival in very elderly colorectal cancer patients.
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Affiliation(s)
- Ryosuke Okamura
- Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan.
| | - Koya Hida
- Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan
| | - Suguru Hasegawa
- Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan
| | - Madoka Hamada
- Department of Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Masayoshi Yasui
- Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - Takao Hinoi
- Department of Gastroenterological and Transplant Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Tei M, Wakasugi M, Kishi K, Tanemura M, Akamatsu H. Incidence and risk factors of postoperative delirium in elderly patients who underwent laparoscopic surgery for colorectal cancer. Int J Colorectal Dis 2016; 31:67-73. [PMID: 26243471 DOI: 10.1007/s00384-015-2335-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The reported incidence of postoperative delirium (POD) in elderly patients ranges from 6 to 53 %. Several preoperative and operative factors have been reported as risk factors of POD. AIM The aim of this study was to determine the incidence of and risk factors for POD in patients with colorectal cancer who had undergone laparoscopic colorectal resection. METHODS A total of 311 consecutive patients aged 75 years and older who underwent laparoscopic surgery for colorectal cancer at our department from January 2008 to December 2013 were classified as delirious group (n = 44) and nondelirious group (n = 267). Short-term outcomes and risk factors for POD were analyzed. RESULTS POD was diagnosed in 14.1 % of elderly patients with colorectal cancer. Univariate analysis showed that older age, high American Society of Anesthesiology (ASA) score, performance status >2, low prognostic nutrition index (PNI), past history of delirium or dementia, operative approach, Organ/Space SSI, and cardiac or pulmonary disease were significantly associated with POD. Multivariate logistic regression analysis identified older age, past history of delirium or dementia, operative approach, and Organ/Space SSI as four independent risk factors for POD. CONCLUSIONS Our results suggest that the risk of POD is associated with older age, past history of delirium or dementia, operative approach, Organ/Space SSI.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan.
| | - Masaki Wakasugi
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan
| | - Masahiro Tanemura
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan
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Short-term outcomes between laparoscopy-assisted and open colorectomy for colorectal cancer in elderly patients: A case-matched control study. Mol Clin Oncol 2015; 3:1155-1159. [PMID: 26623069 DOI: 10.3892/mco.2015.585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/27/2015] [Indexed: 11/05/2022] Open
Abstract
With the increase in life expectancy, surgical intervention for colorectal cancer (CRC) is more frequently performed in elderly patients. This retrospective study was designed to compare short-term outcomes between laparoscopy-assisted colorectomy (LC) and open colorectomy (OC) in elderly patients with CRC. A total of 89 CRC patients aged ≥75 years undergoing LC were matched with 89 counterparts undergoing OC. The matching criteria included general information and preoperative status. The operative data and short-term postoperative outcomes were compared. Following analysis, patients in the LC and OC groups were comparable for the matching criteria. Compared with the OC group, the operative time was longer (P=0.046), but the estimated blood loss (P<0.001) and intraoperative transfusion (P=0.042) were less in the LC group. As regards short-term postoperative outcomes, the duration of postoperative hospital stay was shorter (P=0.001) and the incidence of wound complications was lower (P=0.044) with LC. The overall complication, other complications, reoperation and mortality rates were comparable between the two groups. In conclusion, considering the operative variables and short-term outcomes, LC is a safe procedure and appears to be superior to OC for elderly patients with CRC.
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Schiphorst AHW, Verweij NM, Pronk A, Borel Rinkes IHM, Hamaker ME. Non-surgical complications after laparoscopic and open surgery for colorectal cancer - A systematic review of randomised controlled trials. Eur J Surg Oncol 2015; 41:1118-27. [PMID: 25980746 DOI: 10.1016/j.ejso.2015.04.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/03/2015] [Accepted: 04/14/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiac and pulmonary complications account for a large part of postoperative mortality, especially in the growing number of elderly patients. This review studies the effect of laparoscopic surgery for colorectal cancer on short term non-surgical morbidity. METHODS A literature search was conducted to identify randomised trials on laparoscopic compared to open surgery for colorectal cancer with reported cardiac or pulmonary complications. RESULTS The search retrieved 3302 articles; 18 studies were included with a total of 6153 patients. Reported median or mean age varied from 56 years to 72 years. The percentage of included patients with ASA-scores ≥ 3 ranged from 7% to 38%. Morbidity was poorly defined. Overall reported incidence of postoperative cardiac complications was low for both laparoscopic and open colorectal resection (median 2%). There was a trend towards fewer cardiac complications following laparoscopic surgery (OR 0.66, 95% CI 0.41-1.06, p = 0.08), and this effect was most marked for laparoscopic colectomy (OR 0.28, 95% CI 0.11-0.71, p = 0.007). Incidence of pulmonary complications ranged from 0 to 11% and no benefit was found for laparoscopic surgery, although a possible trend was seen in favour of laparoscopic colectomy (OR 0.78, 95% CI 0.53-1.13, p = 0.19). Overall morbidity rates varied from 11% to 69% with a median of 33%. CONCLUSION Although morbidity was poorly defined, for laparoscopic colectomies, significantly less cardiac complications occurred compared with open surgery and a trend towards less pulmonary complications was observed. Subgroup analysis from two RCTs suggests that elderly patients benefit most from a laparoscopic approach based on overall morbidity rates.
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Affiliation(s)
| | - N M Verweij
- Dept. of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - A Pronk
- Dept. of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - I H M Borel Rinkes
- Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M E Hamaker
- Dept. of Geriatric Medicine, Diakonessenhuis, Utrecht and Zeist, The Netherlands
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Seishima R, Okabayashi K, Hasegawa H, Tsuruta M, Shigeta K, Matsui S, Yamada T, Kitagawa Y. Is laparoscopic colorectal surgery beneficial for elderly patients? A systematic review and meta-analysis. J Gastrointest Surg 2015; 19:756-65. [PMID: 25617077 DOI: 10.1007/s11605-015-2748-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/07/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Elderly patients who undergo major abdominal surgery are potentially at a higher risk of perioperative mortality and postoperative complications. Although laparoscopic surgery has been widely accepted as a less invasive surgical procedure for colorectal diseases, the benefits for elderly patients have not been validated. AIM To compare postoperative outcomes and long-term survival between laparoscopic and open colorectal surgery in the elderly population. METHODS A literature search was electronically performed to identify all studies comparing postoperative outcomes between laparoscopic and open colorectal resections in the elderly population. Primary outcomes were postoperative mortality and complications, and the secondary outcome was long-term survival. RESULTS Overall, 30 studies (70,946 patients) met our inclusion criteria. Laparoscopic surgery was significantly associated with a decreased risk of perioperative mortality [odds ratio (OR), 0.55; 95% confidence interval (CI), 0.45-0.68; P < 0.01] and postoperative complications (OR, 0.55; 95% CI, 0.48-0.63; P < 0.01) compared with open surgery. There was no significant difference in long-term survival between the two procedures (OR, 0.89; 95% CI, 0.72-1.07; P = 0.31). CONCLUSIONS Laparoscopic colorectal surgery in the elderly population has significant advantages in terms of short-term outcomes. Aggressive application of laparoscopic colorectal surgery should be considered for the elderly population.
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Affiliation(s)
- Ryo Seishima
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 1608582, Japan
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Inoue Y, Kawamoto A, Okugawa Y, Hiro J, Saigusa S, Toiyama Y, Araki T, Tanaka K, Mohri Y, Kusunoki M. Efficacy and safety of laparoscopic surgery in elderly patients with colorectal cancer. Mol Clin Oncol 2015; 3:897-901. [PMID: 26171203 DOI: 10.3892/mco.2015.530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/26/2015] [Indexed: 01/14/2023] Open
Abstract
Colorectal cancer (CRC) is predominantly a disease of the elderly. Elderly patients may also exhibit poorer outcomes due to the increased burden of comorbidities, functional dependency and limited life expectancy. The aim of this study was to evaluate the outcome of laparoscopic surgery in elderly patients with CRC. A total of 148 patients who underwent laparoscopic surgery at our institution between January, 2000 and December, 2011 were enrolled. We compared the differences between elderly patients (aged >75 years, n=48) and non-elderly patients (aged <75 years, n=100) and evaluated the demographics and disease-related operative and prognostic data. Postoperative complications occurred in 24 (16.2%) of the 148 patients. The American Society of Anesthesiologists score and comorbidity were found to be significantly correlated with complications and the multivariate analysis demonstrated that pulmonary disease, but not age, was an independent factor affecting postoperative complications (odds ratio = 3.21, 95% confidence interval: 1.02-10.14, P=0.0470). Patients with pulmonary comorbidities also exhibited similar rates of postoperative complications compared with 259 matched patients who underwent open surgery during same period (41.2 vs. 46.7%, respectively; P=0.7547). In conclusion, chronological age alone should not be considered a contraindication for laparoscopic surgery for CRC in elderly patients. In addition, selection criteria for laparoscopic CRC surgery in elderly as well as non-elderly patients should include pulmonary comorbidities.
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Affiliation(s)
- Yasuhiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Aya Kawamoto
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Yoshinaga Okugawa
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Junichiro Hiro
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Susumu Saigusa
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Toshimitsu Araki
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Koji Tanaka
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Yasuhiko Mohri
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
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Enhanced recovery after colorectal surgery in elderly patients. Wideochir Inne Tech Maloinwazyjne 2015; 10:30-6. [PMID: 25960790 PMCID: PMC4414102 DOI: 10.5114/wiitm.2015.48697] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 10/30/2014] [Accepted: 11/02/2014] [Indexed: 02/04/2023] Open
Abstract
Introduction The elderly will soon constitute 20% of the population. Their number is constantly rising, particularly in developed countries. It was found that they particularly benefit from the use of minimally invasive surgery. The Enhanced Recovery After Surgery (ERAS) protocol may further improve clinical outcomes in this group of patients. Aim To assess the implementation of the ERAS protocol in elderly patients submitted to laparoscopic colorectal surgery. Material and methods Ninety-two patients who underwent elective laparoscopic colorectal surgery were included in the study. Patients were divided into group 1 (≤ 65 years) and group 2 (> 65 years). Perioperative care was based on ERAS Society guidelines. Length of hospital stay, time of first stool passage, perioperative complications and readmissions were analyzed. Results Group 2 patients had higher ASA grades in comparison to group 1. In all cases, oral fluid intake started on the day of surgery. The groups did not differ according to oral fluid tolerance, first stool passage time or length of hospital stay. Number and character of perioperative complications were comparable between the two groups. Four patients were readmitted within 30 days after discharge. One patient required reoperation. Conclusions Implementation of the ERAS protocol is possible regardless of the age of surgical patients. Its use in the elderly allows the length of hospitalization to be shortened and is not associated with higher risk of postoperative complications or readmissions.
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Soma T, Sugano M, Kawasaki C, Tsuji M, Fukui I. Colorectal resection in nonagenarians: effectiveness of laparoscopic surgery. Asian J Endosc Surg 2014; 7:222-6. [PMID: 24734979 DOI: 10.1111/ases.12105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/25/2014] [Accepted: 03/16/2014] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The number and proportion of elderly persons in the general population have been increasing. Inevitably, the incidence of colorectal carcinoma has also increased. Although substantial evidence indicates that surgery is well tolerated in patients 80 years or older, studies in nonagenarians are not well documented. METHODS Consecutive nonagenarians and octogenarians who underwent elective laparoscopic-assisted colectomy (LAC) from September 2009 through October 2011 were studied. Data on medical history, ASA score, details of operations, and postoperative events were collected. RESULTS LAC was performed in nine nonagenarians and seven octogenarians. There were no complications related to laparoscopy. No patient required conversion from LAC to an open procedure or died postoperatively. Peristalsis was confirmed and oral intake was initiated on postoperative days 2.6 and 2.7, respectively. CONCLUSIONS Laparoscopic surgery is considered an extremely useful treatment for very old patients because it has a low risk of postoperative complications, even in the presence of pre-existing diseases. We conclude that LAC may be indicated in nonagenarians.
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Affiliation(s)
- Toshiya Soma
- Department of Surgery, Kansai Electric Power Hospital, Osaka, Japan; Department of Surgery, Obama Municipal Hospital, Obama, Japan; Department of Surgery, Moriyama Municipal Hospital, Moriyama, Japan
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Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients. Surg Endosc 2014; 29:322-33. [PMID: 24986017 DOI: 10.1007/s00464-014-3672-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/06/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Increasing life expectancy requires specific attention on geriatric patients. Data support a potential reduction of surgical morbidity for patients undergoing laparoscopic surgery as compared to conventional surgery. The aim of this study was to investigate the comparative effect of laparoscopic and open colorectal surgery on geriatric patients. METHODS A systematic review of electronic information sources was undertaken. Studies that provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open colorectal surgery, were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was independently appraised by two reviewers. Random effects model was applied to synthesize outcome data. RESULTS Twenty-seven articles providing data for 66,592 patients were included in the analysis. Patients undergoing laparoscopic surgery had a decreased risk for mortality (2.2 vs. 5.4 %; OR 0.55, 95 % CI 0.44-0.67), overall morbidity (19.3 vs. 26.7 %; OR 0.54, 95 % CI 0.46-0.63), cardiac (4.7 vs. 7.7 %; OR 0.60, 95 % CI 0.39-0.92) and respiratory complications (3.9 vs. 6.3 %; OR 0.67, 95 % CI 0.47-0.95). Sensitivity analysis including reports with similar age, American Society of Anesthesiologists score and/or similar prevalence of cardiopulmonary morbidity between the laparoscopic and the open treatment arm validated the outcome estimates of the primary analysis. CONCLUSIONS This analysis supports a substantial benefit for elderly patients undergoing laparoscopic in comparison with open colorectal surgery. The comparative effect of either approach on geriatric patients with pulmonary and cardiac comorbidities is a subject of further investigation.
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Cheng Y, Jayprakash G, Shen XF. Laparoscopic Surgery for Carcinoma of the Colorectum: A Safe and Effective Approach in Elderly Patients. INT J GERONTOL 2013. [DOI: 10.1016/j.ijge.2013.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery. Surg Endosc 2013; 27:4463-8. [PMID: 23877762 DOI: 10.1007/s00464-013-3088-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/20/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Elderly patients often are regarded as high-risk for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The goal of this study was to compare the cost of care and short-term outcomes of elderly and nonelderly patients undergoing laparoscopic colectomy. Our hypothesis was that elderly patients managed with laparoscopic colorectal surgery and an enhanced recovery protocol (ERP) can realize the same benefits of lower hospital length of stay (LOS) without increasing hospital costs or readmission rates. METHODS Review of a prospective database identified all patients that underwent an elective laparoscopic colectomy from 2009 to 2012. Patients were stratified into elderly (≥70 years old) and nonelderly (<70 years old) cohorts. The main outcome measures were discharge disposition, hospital costs, hospital LOS, and 30-day readmission rates between the laparoscopic and open groups. RESULTS A total of 302 nonelderly (66%) and 153 elderly (34%) patients were included in the analysis. The elderly cohort had significantly higher comorbidities than the nonelderly group. There were no mortalities. Operative variables (procedure time, blood loss, and intraoperative complications) were similar. At discharge, significantly more elderly patients required temporary nursing or home care. There were no significant differences in short-term outcomes of LOS, 30-day readmission rates, or costs for the episode of care between the two groups. CONCLUSIONS Combining laparoscopic colectomy with an ERP is cost-effective and results in similar short-term outcomes for the elderly and nonelderly patients. Despite higher comorbidities, elderly patients realized the same benefits of shorter LOS with similar hospital costs and readmission rates.
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The impact of old age on surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. Surg Endosc 2013; 27:3990-7. [PMID: 23877760 DOI: 10.1007/s00464-013-3073-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 06/14/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Old age is regarded as the risk factor of major abdominal surgery due to the lack of functional reserve and the increased presence of comorbidities. This study aimed to evaluate the impact of old age on the surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. METHODS This study enrolled 389 gastric cancer patients who underwent totally laparoscopic gastrectomy at Hanyang University Guri Hospital and ASAN Medical Center. The patients were classified into two groups according to age as those older than 70 years and those younger than 70 years. Early surgical outcomes such as operation time, postoperative complications, time to first flatus, days until soft diet began, and hospital stay were evaluated. RESULTS No patient was converted to open surgery. The two groups differed significantly in terms of overall postoperative complication rate, time to first flatus, days until soft diet began, and hospital stay. The patients who underwent Roux-en-Y gastrojejunostomy differed in incidence of postoperative ileus but not in severe postoperative complication rate. CONCLUSIONS The results of this study demonstrated that old age can have an effect on the surgical outcomes of totally laparoscopic gastrectomy. This study especially showed that elderly patients are affected by the return of bowel movement after totally laparoscopic gastrectomy. On the other hand, however, it is presumed that old age has not had a serious impact on surgical outcomes in totally laparoscopic gastrectomy because no difference in the severe postoperative complication rate was observed.
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Bottino V, Esposito MG, Mottola A, Marte G, Di Maio V, Sciascia V, Nunziante M, Fregola G, Cuzzovaglia S, Galante F, Andreoli F, Breglia A, Giuliano ME, Papaleo D, Della Rocca P, Maida P. Early outcomes of colon laparoscopic resection in the elderly patients compared with the younger. BMC Surg 2012; 12 Suppl 1:S8. [PMID: 23173882 PMCID: PMC3499266 DOI: 10.1186/1471-2482-12-s1-s8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to define any benefits in terms of early outcome for laparoscopic colectomy in patients over 75 years old (OP) compared with the outcomes of a younger populations (YP). METHODS Forty elderly patients undergoing laparoscopic colectomy for colorectal cancer between 2007-2011 were studied, the patients are divided for gender, age, year of surgery, site of cancer, and comorbidity on admission and compared with 40 younger patients. RESULTS AND DISCUSSION Mean (standard deviation) age was 81.3 in OP and 68.3 YP Conversion rate was the same between the two groups. There was no difference in operative mean time . The overall mortality rate was 0% percent. The surgical morbidity rate was the same but there was an increased in cardiologic e bronchopneumonia complications in older population. Patients treated with laparoscopic approach had a faster recovery of bowel function and a significant reduction of the mean length of hospital stay not age related. Laparoscopy allowed a better preservation of postoperative independence status. CONCLUSIONS Laparoscopic colectomy for cancer in elderly patients is safe and beneficial including preservation of postoperative independence and a reduction of length of hospital stay.
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Affiliation(s)
- Vincenzo Bottino
- Evangelic Hospital Villa Betania, Via Argine 604, Naples, Italy.
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She WH, Poon JTC, Fan JKM, Lo OSH, Law WL. Outcome of laparoscopic colectomy for cancer in elderly patients. Surg Endosc 2012; 27:308-12. [PMID: 22820704 DOI: 10.1007/s00464-012-2466-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 06/13/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resection for colon cancer in the elderly is a major undertaking. However, data on the outcome and survival of elderly patients who underwent laparoscopic resection for colon cancer are limited. This study of patients older than 75 years compared outcome and survival between those who underwent laparoscopic resection and those who had open resection for colorectal cancer. METHODS From 2000 to 2009, 434 patients ages 75 years and older who underwent elective resection for colon cancer were included in the study. Patients who had rectal cancer or had undergone emergency operations were excluded. Preoperative diagnosis was determined by colonoscopy, and computed tomography scan was performed for preoperative staging. Data on the patients' demographics, operative details, pathology results, postoperative results, and survival were collected prospectively. The patients who underwent laparoscopic surgery were compared with those who had open surgery. RESULTS The study included 434 patients (210 men) with a median age of 80 years (range 75-95 years). Of these 434 patients, 189 underwent laparoscopic resection. Nine patients (4.8%) required conversion to open operation. The patients did not differ in terms of age, gender, incidence of medical comorbidities, or stage of disease. The median operating time was longer in the laparoscopic group, but the blood loss was significantly less. Laparoscopic resection was associated with a lower mortality rate and a shorter hospital stay (p < 0.05). The open resection group had significantly more cardiac complications (p < 0.05). The overall 5-year survival rates were similar between the patients who had laparoscopic resections and those who had open surgery. CONCLUSIONS For patients older than 75 years, laparoscopic resection of colon is associated with less intraoperative blood loss, a shorter hospital stay, fewer cardiac complication, and a lower mortality rate than open resection. Therefore, the authors recommend laparoscopic resection of colon cancer as the treatment of choice for elderly patients.
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Affiliation(s)
- Wong-Hoi She
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
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Tan WS, Chew MH, Lim IAL, Ng KH, Tang CL, Eu KW. Evaluation of laparoscopic versus open colorectal surgery in elderly patients more than 70 years old: an evaluation of 727 patients. Int J Colorectal Dis 2012; 27:773-80. [PMID: 22134483 DOI: 10.1007/s00384-011-1375-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND With longer life expectancy, surgeons can expect to operate on older patients. Laparoscopic colorectal (LC) surgery has been demonstrated to be superior to open surgery. Controversy persists, however, regarding benefits of LC in the elderly due to increase in operative time. The aim of our study was to compare short-term outcomes of LC versus open colorectal (OC) surgery in elderly patients. MATERIALS AND METHODS Patients ≥70 years old that underwent elective LC between 2005 and 2008 were compared with controls who underwent OC. Data was extracted from a prospectively collected database. RESULTS Seven hundred and twenty-seven patients underwent colorectal resection in this study period (LC n = 225, OC n = 502). The laparoscopic arm was characterised by shorter incisions (LC 6.0 cm vs. OC 12.0 cm, p < 0.001) but longer operating times (LC 125 min vs. OC 85 min, p < 0.001). Median use of narcotics and length of stay were significantly shorter in the laparoscopic group (LC 2 days vs. OC 3 days, p < 0.001 and LC 6 days vs. OC 7 days, p < 0.001, respectively). There was no significant difference in median recovery of bowel function (LC 4 days vs. OC 4 days, p = 0.14) and post-operative morbidity (p = 0.725). Thirty-day mortality was significantly lower in the laparoscopic arm (LC 1.3% vs. OC 4.6%, p = 0.03) CONCLUSION This is the largest series from a single institution comparing LC and OC in elderly patients. In our series, LC in elderly patients was safe and not associated with a higher morbidity. LC was also associated with less narcotic use and shorter length of stay.
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Affiliation(s)
- Wah Siew Tan
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
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Expert opinion on laparoscopic surgery for colorectal cancer parallels evidence from a cumulative meta-analysis of randomized controlled trials. PLoS One 2012; 7:e35292. [PMID: 22532846 PMCID: PMC3332109 DOI: 10.1371/journal.pone.0035292] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 03/14/2012] [Indexed: 12/13/2022] Open
Abstract
Background This study sought to synthesize survival outcomes from trials of laparoscopic and open colorectal cancer surgery, and to determine whether expert acceptance of this technology in the literature has parallel cumulative survival evidence. Study Design A systematic review of randomized trials was conducted. The primary outcome was survival, and meta-analysis of time-to-event data was conducted. Expert opinion in the literature (published reviews, guidelines, and textbook chapters) on the acceptability of laparoscopic colorectal cancer was graded using a 7-point scale. Pooled survival data were correlated in time with accumulating expert opinion scores. Results A total of 5,800 citations were screened. Of these, 39 publications pertaining to 23 individual trials were retained. As well, 414 reviews were included (28 guidelines, 30 textbook chapters, 20 systematic reviews, 336 narrative reviews). In total, 5,782 patients were randomized to laparoscopic (n = 3,031) and open (n = 2,751) colorectal surgery. Survival data were presented in 16 publications. Laparoscopic surgery was not inferior to open surgery in terms of overall survival (HR = 0.94, 95% CI 0.80, 1.09). Expert opinion in the literature pertaining to the oncologic acceptability of laparoscopic surgery for colon cancer correlated most closely with the publication of large RCTs in 2002–2004. Although increasingly accepted since 2006, laparoscopic surgery for rectal cancer remained controversial. Conclusions Laparoscopic surgery for colon cancer is non-inferior to open surgery in terms of overall survival, and has been so since 2004. The majority expert opinion in the literature has considered these two techniques to be equivalent since 2002–2004. Laparoscopic surgery for rectal cancer has been increasingly accepted since 2006, but remains controversial. Knowledge translation efforts in this field appear to have paralleled the accumulation of clinical trial evidence.
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Laparoscopy for sigmoid colon and rectal cancers in septuagenarians: a retrospective, comparative study. Tech Coloproctol 2012; 16:213-9. [PMID: 22434543 DOI: 10.1007/s10151-012-0817-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 02/19/2012] [Indexed: 01/30/2023]
Abstract
BACKGROUND The aim of the study is to analyze the results of laparoscopy in septuagenarians with sigmoid colon or rectal cancer. METHODS Patients who underwent laparoscopic or hand-assisted laparoscopic sigmoid or rectal resections for cancer were retrospectively selected from the database of our institution. The study group (Lap > 70 group), contained the cancer patients over 70 years old who were treated with laparoscopy. Patients less than 70 years old who underwent a laparoscopic procedure (Lap < 70 group), and those over than 70 years old who underwent conventional surgery (Open > 70 group), were assigned to control groups. Demographics, information regarding tumors, perioperative data, pathological results, and survival in the three groups were compared. RESULTS There were 56, 166, and 34 patients in the Lap > 70, Lap < 70, and Open > 70 groups, respectively. Patients in the Lap > 70 group were significantly older than other groups. The American Society of Anesthesiologists scores were higher, and the presence of the studied risk factors was more common in the Lap > 70 group than the Lap < 70 group. Intraoperative bleeding and the amount and number of perioperative transfusions required were less in the Lap > 70 group than in the Open > 70 group. The number of harvested lymph nodes was less in the Lap > 70 group than both study groups. Five-year survival in the Lap > 70 group was similar to that in the Lap < 70 group and significantly better than in the Open > 70 group. CONCLUSIONS Laparoscopy for sigmoid colon and rectal cancer in patients over 70 may be feasible and safe as it is in younger patients. The present study has revealed that laparoscopy in the elderly may be superior to conventional techniques as regards some intraoperative findings and survival.
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Fiore JF, Browning L, Bialocerkowski A, Gruen RL, Faragher IG, Denehy L. Hospital discharge criteria following colorectal surgery: a systematic review. Colorectal Dis 2012; 14:270-81. [PMID: 20977587 DOI: 10.1111/j.1463-1318.2010.02477.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to identify and synthesize the hospital discharge criteria that have been used in the colorectal surgery literature. METHODS A systematic literature search was conducted using eight bibliographic databases. Searches were limited to English language journal articles published between January 1996 and October 2009. Primary research applying hospital discharge criteria following colorectal surgery was included. Study selection was made independently by two reviewers. Discharge criteria were extracted from each included study. RESULTS The 156 studies identified by the search strategy described 70 different sets of criteria to indicate readiness for discharge. The majority of studies applied a combination of three or four criteria; those most frequently cited were tolerance of oral intake (80%), return of bowel function (70%), adequate pain control (44%) and adequate mobility (35%). End-points employed to determine the achievement of criteria were generally poorly defined. CONCLUSION A variety of hospital discharge criteria were applied in the colorectal surgery literature. Development of standardized criteria will allow more accurate comparison of results between studies assessing hospital length of stay or other discharge-related outcome measures.
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Affiliation(s)
- J F Fiore
- Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia.
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Martel G, Duhaime S, Barkun JS, Boushey RP, Ramsay CR, Fergusson DA. The quality of research synthesis in surgery: the case of laparoscopic surgery for colorectal cancer. Syst Rev 2012; 1:14. [PMID: 22588035 PMCID: PMC3351744 DOI: 10.1186/2046-4053-1-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 02/17/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several systematic reviews and meta-analyses populate the literature on the effectiveness of laparoscopic surgery for colorectal cancer. The utility of this body of work is unclear. The objective of this study was to synthesize all such systematic reviews in terms of clinical effectiveness, to appraise their quality, and to determine whether areas of duplication exist across reviews. METHODS Systematic reviews comparing laparoscopic and open surgery for colorectal cancer were identified using a comprehensive search protocol (1991 to 2008). The primary outcome was overall survival. The methodological quality of reviews was appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Abstraction and quality appraisal was carried out by two independent reviewers. Reviews were synthesized, and outcomes were compared qualitatively. A citation analysis was carried out using simple matrices to assess the comprehensiveness of each review. RESULTS In total, 27 reviews were included; 13 reviews included only randomized controlled trials. Rectal cancer was addressed exclusively by four reviews. There was significant overlap between review purposes, populations and, outcomes. The mean AMSTAR score (out of 11) was 5.8 (95% CI: 4.6 to 7.0). Overall survival was evaluated by ten reviews, none of which found a significant difference. Three reviews provided a selective meta-analysis of time-to-event data. Previously published systematic reviews were poorly and highly selectively referenced (mean citation ratio 0.16, 95% CI: 0.093 to 0.22). Previously published trials were not comprehensively identified and cited (mean citation ratio 0.56, 95% CI: 0.46 to 0.65). CONCLUSIONS Numerous overlapping systematic reviews of laparoscopic and open surgery for colorectal cancer exist in the literature. Despite variable methods and quality, survival outcomes are congruent across reviews. A duplication of research efforts appears to exist in the literature. Further systematic reviews or meta-analyses are unlikely to be justified without specifying a significantly different research objective. This works lends support to the registration and updating of systematic reviews.
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Affiliation(s)
- Guillaume Martel
- Department of Surgery, Department of Epidemiology & Community Medicine, and Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
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Roscio F, Bertoglio C, De Luca A, Frigerio A, Galli F, Scandroglio I. Outcomes of laparoscopic surgery for colorectal cancer in elderly patients. JSLS 2011; 15:315-21. [PMID: 21985716 PMCID: PMC3183545 DOI: 10.4293/108680811x13125733357070] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Laparoscopic colorectal surgery appears to be feasible and safe in elderly patients with increased comorbidity. Objective: To evaluate the short-term outcomes of laparoscopic colorectal surgery for cancer in the elderly compared with younger patients. Methods: We retrospectively considered a consecutive unselected series of 159 patients who underwent elective laparoscopic procedures for colorectal cancer at our institution between January 2007 and December 2009. Of these patients, 101 (63.5%) were ≤70 years of age (Group A), and 58 (36.5%) were >70 (Group B). Operative steps and instrumentation were standardized. Demographics, disease-related, operative, and short-term data were analyzed for each group, and an appropriate statistical comparison was made. Comorbidity was quantified by using the Charlson Comorbidity Index. Results: We reviewed right colectomies (29.5%), left colectomies (44.7%), rectal resections (19.5%), and other procedures (6.3%). There was no significant difference in sex ratio, body mass index, American Society of Anesthesiology score, type of surgical procedures, and tumor stage between Group A and Group B. A statistically higher comorbidity according to the Charlson index characterized Group B (2.2 vs 3.8; P=.034). Median operative time (228±78.1min vs 224.3±97.6min; NS), estimated blood loss (50.0±94.8mL vs 31.2±72.7mL; NS), conversion rate (2.0% vs 1.7%; NS), and timing to canalization (4.5±1.7dd vs 4.4±1.3dd; NS) were statistically comparable in both Groups. Group B was associated with a significantly longer length of hospital stay compared with Group A (8.1±2.8dd vs 10.8±6.6dd; P<.01) There was no statistically significant difference in major postoperative complications (3.8% vs 3.4%; NS), reoperations (0.9% vs 1.7%; NS), and 30-day mortality (0% vs 1.7%; NS). Conclusions: Laparoscopic colorectal surgery appears feasible and safe in elderly patients with increased comorbidity.
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Affiliation(s)
- Francesco Roscio
- Department of General Surgery, Presidio Ospedaliero "Galmarini"-Tradate; Azienda Ospedaliera "Ospedale di Circolo" - Busto Arsizio-Italy. francesco_roscio@ yahoo.it
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Kaltoft B, Gögenur I, Rosenberg J. Reduced length of stay and convalescence in laparoscopic vs open sigmoid resection with traditional care: a double blinded randomized clinical trial. Colorectal Dis 2011; 13:e123-30. [PMID: 21564464 DOI: 10.1111/j.1463-1318.2011.02550.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM The effect of a laparoscopic technique without a multi-modal rehabilitation programme but with traditional postoperative care was studied in a blinded randomized trial regarding nursing time, hospital stay, pain, fatigue, need for sleep and return to normal daily activities. METHOD Eighteen patients with sigmoid cancer were randomly assigned to laparoscopic (n = 10) and open (n = 8) colonic resection in a double blinded trial. Length of hospital stay, fulfillment of discharge criteria, need for nursing care (information given to the patient, physical care and indirect care) and postoperative pain were recorded. Furthermore, the patients filled out a questionnaire regarding fatigue, need for sleep and return to daily activities 14 and 30 days postoperatively. RESULTS The laparoscopic technique reduced length of hospital stay from 7 to 4.5 days (P = 0.006), although both groups met the discharge criteria on the third postoperative day. There were no significant differences in total need for nursing time during hospitalization between the two groups (P = 0.328). The laparoscopic group had less pain 24 hours after operation (P = 0.040), and reported less fatigue and reduced need for sleep during the day 30 days after surgery when compared with open surgery (P = 0.033 and P = 0.036, respectively). Furthermore, the laparoscopic group returned significantly faster to normal daily activities after surgery (P = 0.023). CONCLUSION Laparoscopic surgery per se reduced hospital stay, pain and convalescence compared with open surgery in patients undergoing colonic resection.These effects were obtained without a fast track programme and without an increase in nursing staff on the general surgical ward.
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Affiliation(s)
- B Kaltoft
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
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Abstract
INTRODUCTION The aim of this study was to evaluate whether elderly patients with colorectal cancer benefit from laparoscopic colon surgery (LAC) in comparison to open colon surgery (OC). METHODS Patients with colon cancer were divided into four groups; >75 years (CC(>75) ) [LAC(>75) (n=36), OC(>75) (n=15)] and ≤75 years [LAC(≤75) (n=90), OC(≤75) (n=26)]. Differences in postoperative short-term outcomes were analyzed among the age and procedure groups. RESULTS Intraoperative blood loss was significantly less in the LAC(>75) group (68 ± 168 ml) than in the OC(>75) group (118 ± 130 ml, P=0.040). The C-reactive protein of patients in the OC(>75) group (5.4 ± 2.2 mg/dl) tended to be less than that of the LAC(>75) group (6.1 ± 2.8 mg/dl, P=0.080) on postoperative day 1. The time to the first passage of flatus was significantly shorter in the LAC(>75) group (2.0 ± 0.7 days) than in the OC(>75) group (2.7 ± 0.8 days, P=0.003). Postoperative hospital stays were also shorter in the LAC(>75) group (14.2 ± 9.4 days) than in the OC(>75) group (18.0 ± 8.3 days, P=0.038). No mortality was registered in the LAC(>75) group, while one patient in the OC(>75) group died during the postoperative course. The rate of postoperative morbidity was similar between the LAC(>75) and OC(>75) groups [13.9% (5/36) versus 20.0% (3/15), P=0.679]. CONCLUSION LAC provides some advantages over OC in patients with colon cancer aged >75 years as well as in those aged ≤75 years. LAC can be safely performed in very elderly patients with colon cancer.
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Affiliation(s)
- Y Tomimaru
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
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Postoperative complications in elderly patients with colorectal cancer: comparison of open and laparoscopic surgical procedures. Surg Laparosc Endosc Percutan Tech 2011; 19:488-92. [PMID: 20027093 DOI: 10.1097/sle.0b013e3181bd9562] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Surgery is associated with higher morbidity and mortality rates in elderly patients with colorectal cancer compared with younger patients. The aim of this study was to examine preoperative evaluation for selecting operative procedure in elderly patients with colorectal cancer. METHODS The study of all patients who underwent open surgery (OS) or laparoscopically assisted surgery (LAS) for colorectal cancer from January 2004 to December 2007 were aged > or =71 years. Preoperative evaluation, operative factors, morbidity, and mortality were analyzed by the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) and Prognostic Nutritional Index (PNI). RESULTS A total of 129 patients were included in this study. Fifty-one patients underwent OS, and LAS was performed on 78 patients. The morbidity rate was 51.3% (40 patients) for the OS group and 23.5% (12 patients) for the LAS group. Three LAS patients (5.9%) subsequently required OS. One LAS patient died postoperatively. There were significant differences in the Operative Severity Score (OSS) in POSSUM and PNI, but not Physiologic Score (PS) in POSSUM, between the two groups. In the OS group, there were significant differences in PS, OSS, and PNI between those with or without complications, whereas in the LAS group, OSS, but not PS or PNI, was significantly lower in those without than in those with complications. CONCLUSIONS Compared with OS, LAS is associated with a lower incidence of complications in elderly patients with colorectal cancer. The nutritional status correlated with postoperative complications in the OS group.
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Poon JTC, Law WL, Chow LCY, Fan JKM, Lo SH. Outcome of Laparoscopic Resection for Colorectal Cancer in Patients with High Operative Risk. Ann Surg Oncol 2011; 18:1884-90. [DOI: 10.1245/s10434-010-1530-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Indexed: 12/20/2022]
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Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 2010; 97:1638-45. [PMID: 20629110 DOI: 10.1002/bjs.7160] [Citation(s) in RCA: 692] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The UK Medical Research Council CLASICC trial assessed the safety and efficacy of laparoscopically assisted surgery in comparison with open surgery for colorectal cancer. The results of the 5-year follow-up analysis are presented. METHODS Five-year outcomes were analysed and included overall and disease-free survival, and local, distant and wound/port-site recurrences. Two exploratory analyses were performed to evaluate the effect of age (70 years or less, or more than 70 years) on overall survival between the two groups, and the effect of the learning curve. RESULTS No differences were found between laparoscopically assisted and open surgery in terms of overall survival, disease-free survival, and local and distant recurrence. Wound/port-site recurrence rates in the laparoscopic arm remained stable at 2.4 per cent. Conversion to open operation was associated with significantly worse overall but not disease-free survival, which was most marked in the early follow-up period. The effect of surgery did not differ between the age groups, and surgical experience did not impact on the 5-year results. CONCLUSION The 5-year analyses confirm the oncological safety of laparoscopic surgery for both colonic and rectal cancer. The use of laparoscopic surgery to maximize short-term outcomes does not compromise the long-term oncological results. REGISTRATION NUMBER ISRCTN74883561 (http://www.controlled-trials.com).
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Affiliation(s)
- D G Jayne
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds, UK.
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Fiscon V, Portale G, Frigo F, Migliorini G. Laparoscopic resection of colorectal cancer: matched comparison in elderly and younger patients. Tech Coloproctol 2010; 14:323-7. [PMID: 20706759 DOI: 10.1007/s10151-010-0635-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 07/15/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several studies have addressed the issue of the feasibility of laparoscopic colorectal surgery in elderly patients, usually by choosing an arbitrary cut-off age limit, and retrospectively evaluating patient outcomes. The aim of this study was to assess the effects of age on the outcome of laparoscopic colorectal surgery for cancer in a single department, by comparing younger and older patients, matched by ASA score and type of operation. METHODS The perioperative outcome of patients ≥75 years old who underwent laparoscopic colorectal surgery for cancer between June 2005 and January 2009 were compared with findings in younger patients, matched by ASA score and type of operation. RESULTS The study included 100 patients, fifty <75 years old (Group A) and fifty ≥75 (Group B) years old. There were 18 right hemicolectomies, 16 left hemicolectomies, 4 anterior resections, 9 low anterior resections, 2 Miles' operations and 1 segmental resection in each group. We observed a significantly higher overall morbidity rate among elderly patients than among younger patients (24 vs. 8%). CONCLUSIONS Short-term results after laparoscopic colorectal surgery for cancer in patients ≥75 years old reveal that they have higher postoperative risk compared to their younger counterparts, even when matched by ASA score and type of operation. It suggests that although advanced age, per se, is not a contraindication, it is a risk for patients who undergo laparoscopic colorectal surgery for cancer. This surgery in elderly patients should be performed by experienced surgeons in specialized centers to keep postoperative risk to a minimum.
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Affiliation(s)
- V Fiscon
- Department of General Surgery, Azienda ULSS 15 'Alta Padovana', Via Riva Dell' Ospedale, 1, 35013, Cittadella, Padova, Italy.
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Lázár G, Paszt A, Simonka Z, Rokszin R, Abrahám S. [Laparoscopic surgery in colorectal tumors]. Magy Onkol 2010; 54:117-22. [PMID: 20576587 DOI: 10.1556/monkol.54.2010.2.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The minimally invasive technique, by means of the undoubted advantages of the method, has become fully accepted in the surgical treatments of the most benign and functional diseases. Today it has been proven that the laparoscopic technique is safely usable also in the surgical treatment of colorectal tumors. The authors, analyzing their own and the international experiences, present the laparoscopic surgical treatment of colorectal tumors. Seventy-four patients were treated with laparoscopic-assisted colorectal intestinal resection in the Department of Surgery of the University of Szeged between January 1, 2005 and December 31, 2008. The surgical indication was neoplastic colorectal lesion in 40 cases. The average age of them was 64 years (from 36 to 89 years). Four patients belonged to the risk group of ASA I, 11 patients to ASA II, 24 to ASA III, and one to ASA IV. Twenty-six patients underwent rectosigmoideal resection, 2 had rectal exstirpation, 9 had right hemicolectomy and one had left hemicolectomy. There were no surgical or postoperative complications. Four conversions and in one case a reoperation occurred due to adhesion ileus. The startup of the passage (2.4 days, on average) and the possibility of nourishing per os were significantly shortened. The histological processes of specimens justified tumor-free oral, aboral and circumferential resection in all cases. Summarizing our own and international experiences it can be stated that the laparoscopic surgeries performed due to colorectal tumors are safe, and are also appropriate with respect to oncosurgery. There are a number of benefits for the patients mainly in the early postoperative period (faster recovery, shorter hospitalization) and their long-term survival results are good as well.
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Affiliation(s)
- György Lázár
- Szegedi Tudományegyetem, Altalános Orvosi Kar Szent-Györgyi Albert Klinikai Központ, Sebészeti Klinika 6720 Szeged Pécsi u. 6.
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Lian L, Kalady M, Geisler D, Kiran RP. Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians. Surg Endosc 2010; 24:2039-43. [DOI: 10.1007/s00464-010-0900-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 01/06/2010] [Indexed: 12/13/2022]
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Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Yamaguchi T. Short-term outcomes of laparoscopic rectal surgery for primary rectal cancer in elderly patients: is it safe and beneficial? J Gastrointest Surg 2009; 13:1614-8. [PMID: 19582517 DOI: 10.1007/s11605-009-0961-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 06/22/2009] [Indexed: 01/31/2023]
Abstract
PURPOSE The role of laparoscopic resection in management of rectal cancer is still controversial. The purpose of this study was to evaluate whether laparoscopic rectal resection for rectal cancer could be safely performed in elderly patients. METHODS Forty-four elderly patients (> or =75 years) undergoing laparoscopic rectal resection (group A) were compared with 228 younger patients (<75 years) undergoing laparoscopic rectal resection (group B) and 43 elderly patients (> or =75 years) undergoing open rectal resection (group C). RESULTS The American Society of Anesthesiologists' status was significantly higher in group A than in group B. Operative procedure, operating time, and estimated blood loss were comparable, and overall postoperative complications did not differ significantly between groups A and B (13.6% vs. 11.8%). Operating time was longer (256 vs. 196 min), but estimated blood loss was significantly less (25 vs. 241 ml) in group A than in group C. The rate of postoperative complications was lower (13.6% vs. 25.6%) in group A than in group C, but the difference was not statistically significant. Time to flatus (1.3 vs. 3.7 days), time to liquid diet (2.2 vs. 7.0 days), and hospital stay (19 vs. 22 days) were significantly shorter in group A than in group C. CONCLUSIONS Laparoscopic rectal resection for elderly patients can be safely performed with similar postoperative outcomes as in younger patients and may have advantages in terms of faster gastrointestinal recovery and shorter length of hospital stay compared with open surgery.
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Affiliation(s)
- Takashi Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Tokyo, Japan
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Otsuka Y, Tsuchiya M, Maeda T, Katagiri T, Isii J, Tamura A, Yamazaki K, Kubota Y, Suzuki T, Suzuki T, Kagami S, Kaneko H. Laparoscopic hepatectomy for liver tumors: proposals for standardization. ACTA ACUST UNITED AC 2009; 16:720-5. [PMID: 19652902 DOI: 10.1007/s00534-009-0139-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/31/2009] [Indexed: 01/28/2023]
Abstract
BACKGROUND/PURPOSE We draw on our experience with laparoscopic hepatectomy (LH) to present recommendations for standardization of LH for the treatment of liver tumors. METHODS At our center, 90 LHs were performed from April 1993 to January 2008. These were divided equally into early cases and late cases, and short-term postoperative results were compared. Forty-nine of the LH procedures were total-laparoscopic procedures, 16 were hand-assisted procedures, and 25 were laparoscopy-assisted procedures. The tumors were malignant in 76 cases and benign in 14 cases. RESULTS Among late cases, the numbers of malignant tumors and tumors located in the posterosuperior region of the liver (Segments VII, VIII, and IVb) were significantly higher than among early cases; however, operative blood loss and postoperative hospital stay were significantly lower in the late cases (158.9 +/- 213.4 vs. 377.6 +/- 421.2 cc, P = 0.007; and 8.7 +/- 3.6 vs. 15.3 +/- 8.7 days, P = 0.0001, respectively). No operative deaths occurred in either group. CONCLUSIONS Although LH does have a steep learning curve, we believe that it can be standardized and provide a less invasive surgical option--with no reduction in disease curability--for the treatment of liver tumors in selected patients.
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Affiliation(s)
- Yuichiro Otsuka
- Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
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Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 2008; 51:296-300. [PMID: 18197453 DOI: 10.1007/s10350-007-9124-0] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 06/01/2007] [Accepted: 07/18/2007] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of laparoscopic colorectal resection on short-term postoperative outcome in elderly patients. METHODS A series of 535 patients with colorectal disease who had been randomly assigned to laparoscopic (n=268) or open (n=267) resection was analyzed. A total of 201 patients (37.6 percent) were elderly (aged 70 years or older) and 334 patients (62.4 percent) were younger than aged 70 years. Follow-up for postoperative morbidity was performed for 30 days after hospital discharge. RESULTS Elderly patients had a higher American Society of Anesthesiologists score compared with younger patients in both the laparoscopic and open groups (P=0.0001). In the open group, elderly patients had higher morbidity rate (37.5 vs. 23.9 percent; P=0.02) and longer length of hospital stay (13 vs. 10.6; P=0.007) compared with younger patients. In the laparoscopic group, morbidity rate (20.2 vs. 15.1 percent) and length of hospital stay (9.5 vs. 9.1) were similar in elderly and younger patients. In elderly patients, the laparoscopy-reduced morbidity rate (20.2 vs. 37.5 percent; P=0.01) and length of hospital stay (9.5 vs. 13; P=0.001) compared to the open approach. In younger patients, the advantages of the laparoscopic approach on morbidity rate (15.1 vs. 23.9 percent; P=0.06) and length of stay (9.1 vs. 10.6; P=0.004) were less pronounced. CONCLUSIONS Laparoscopy improved short-term postoperative outcome more in elderly than in younger patients. Advanced age was associated with higher morbidity and longer length of stay only in patients who underwent open colorectal surgery.
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Affiliation(s)
- Matteo Frasson
- Department of Surgery, San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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Laparoscopic surgery. COLORECTAL CANCER 2007. [DOI: 10.1017/cbo9780511902468.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cheung HYS, Chung CC, Fung JTK, Wong JCH, Yau KKK, Li MKW. Laparoscopic resection for colorectal cancer in octogenarians: results in a decade. Dis Colon Rectum 2007; 50:1905-10. [PMID: 17899275 DOI: 10.1007/s10350-007-9070-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 05/05/2007] [Accepted: 06/13/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study was designed to evaluate the results of laparoscopic resection for colorectal cancer in octogenarians. METHODS Patients aged 80 years or older who underwent elective laparoscopic resection for colorectal cancer from July 1, 1996 to June 30, 2006 were recruited for analysis, with the following exceptions: 1) patients who did not give informed consent; 2) unfit for operative treatment; 3) presented as surgical emergencies; 4) multiple previous abdominal operations; or 5) locally advanced tumors. Operating time, blood loss, length of hospital stay, mortality and morbidities, including anastomotic dehiscence, pulmonary and wound sepsis, disease recurrence, and patient survival were used to measure outcome. RESULTS During a ten-year period, laparoscopic colorectal cancer resection was attempted in 101 octogenarians. The median age was 83 (range, 80-95) years and 45 patients were males. The median operating time was 110 (range, 60-245) minutes, with a median blood loss of 50 (range, 0-1,000) ml. Conversion was required in only one case with a leakage rate of 3.3 percent. The overall morbidity and operative mortality rate were 17 and 3 percent, respectively. With a median follow-up of 24 (range, 0-102) months, 22 patients developed recurrence, with 8 of those still surviving. The overall five-year survival is 51 percent. CONCLUSIONS Our experience confirms that laparoscopic colorectal cancer resection in selected octogenarians is safe and feasible. Aside from the obvious short-term benefits, the long-term oncologic outcomes are favorable.
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Affiliation(s)
- Hester Y S Cheung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, SAR, China.
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Chautard J, Alves A, Zalinski S, Bretagnol F, Valleur P, Panis Y. Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients. J Am Coll Surg 2007; 206:255-60. [PMID: 18222377 DOI: 10.1016/j.jamcollsurg.2007.06.316] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 06/19/2007] [Accepted: 06/25/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND We conducted a prospective case-matched study to compare outcomes of laparoscopic colorectal surgery in elderly (>or= 70 years) and younger (< 70 years) patients. STUDY DESIGN Among 506 consecutive patients who underwent 536 colorectal resections supervised by 1 colorectal surgeon (YP), 75 elderly patients (>or= 70 years)were matched with 103 younger patients (< 70 years), according to gender, body mass index, pathology, and surgical procedure. Postoperative mortality and morbidity were defined as in-hospital deaths and complications. RESULTS One hundred seventy-eight patients (95 men and 83 women) underwent laparoscopic colorectal resection for colorectal carcinoma (40%) or benign diseases (60%). Laparoscopic surgical procedures included left colectomy (43%), rectal resection (34%), right colectomy (12%), subtotal colectomy (6%), and rectopexy (5%). Cardiopulmonary comorbidities were significantly more frequent in elderly compared with young patients (80% versus 33%, p < 0.001). Mean operating times were similar between elderly and young patients (244+/-89 minutes versus 242+/-80 minutes, NS). Thirty-two patients (18%, 16 in each group) required conversion to laparotomy. There was no mortality. Overall postoperative complications were comparable between groups (32% versus 26%, NS). Sixteen patients (9%, 5 elderly and 11 young) required reoperation. Mean hospital stay was comparable between groups (11+/-8 days versus 10+/-9 days, NS). CONCLUSIONS This large case-matched study suggested that laparoscopic colorectal surgery may be proposed in elderly patients, with similar postoperative outcomes as this surgery has in young patients, despite significantly more frequent cardiorespiratory comorbidities.
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Affiliation(s)
- Julien Chautard
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital (AP-HP), Clichy, France
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Abraham NS, Byrne CM, Young JM, Solomon MJ. Meta-analysis of non-randomized comparative studies of the short-term outcomes of laparoscopic resection for colorectal cancer. ANZ J Surg 2007; 77:508-16. [PMID: 17610681 DOI: 10.1111/j.1445-2197.2007.04141.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laparoscopic resection remains to be established as the procedure of first choice for operable colorectal cancer. The aim of the study was to conduct a systematic review of non-randomized comparative studies of laparoscopic resection for colorectal cancer. Published work in English was searched for relevant articles published by the end of 2003. The MOOSE statement was used to conduct the meta-analysis. Study quality was assessed by two investigators using the MINORS tool and the analysis was conducted using Comprehensive Meta-analysis software (Biostat, Englewood, NJ, USA) and Microsoft Excel (Microsoft, Redmond, WA, USA). One thousand two hundred and twenty abstracts were reviewed and 398 articles examined in detail. Out of 108 articles reporting the results of relevant studies, 75 were reports of 64 non-randomized comparative studies. Fifteen studies were excluded. Analysis of the outcomes of 6438 resections showed that the conversion rate was 13.3% with a statistically significant difference between studies with more than 50 versus those with 50 or less attempted resections (11.7 vs 16.5%; P<0.001). Laparoscopic resection took 27.6% (41 min) longer to carry out than open resection. There was no significant difference between the two groups in early mortality rates (1.2 vs 1.1%; P=0.787) or likelihood of re-operation (2.3 vs 1.5%; P=0.319). Laparoscopic resection was associated with a lower morbidity rate (24.05 vs 30.80%, odds ratio (95% confidence interval)=0.77 (0.63-0.95); P=0.014, n=4111, random-effects model). Time until passage of first flatus, passage of a bowel motion, tolerating oral fluids and a solid diet was 1.2-1.6 days (26 to 37%) shorter, measurements of pain and narcotic analgesic requirements were 16-35% lower and hospital stay was 3.5 days (18.8%) shorter following laparoscopic resection compared with open resection. The two approaches were 99% similar in terms of adequacy of oncological clearance. Meta-analysis of non-randomized comparative studies favours laparoscopic over open resection for colorectal cancer. The results were remarkably similar to those of a contemporaneous meta-analysis of randomized controlled trials published by the end of 2002.
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Affiliation(s)
- Ned S Abraham
- The Coffs Harbour Health Campus, Faculty of Medicine, The University of New South Wales, and The Surgical Outcomes Research Centre (SOuRCe), Sydney South West Area Health Service, Australia.
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Sartori CA, D'Annibale A, Cutini G, Senargiotto C, D'Antonio D, Dal Pozzo A, Fiorino M, Gagliardi G, Franzato B, Romano G. Laparoscopic surgery for colorectal cancer: clinical practice guidelines of the Italian Society of Colo-Rectal Surgery. Tech Coloproctol 2007; 11:97-104. [PMID: 17510740 DOI: 10.1007/s10151-007-0345-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Accepted: 03/06/2007] [Indexed: 01/08/2023]
Affiliation(s)
- C A Sartori
- San Giacomo Apostolo Hospital, Castelfranco Veneto (TV), Italy
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Sarli L, Iusco DR, Regina G, Sansebastiano G, Ferro M, Veronesi L, Roncoroni L. Predicting conversion to open surgery in laparoscopic left hemicolectomy. Surg Laparosc Endosc Percutan Tech 2007; 16:212-6. [PMID: 16921298 DOI: 10.1097/00129689-200608000-00003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The objective of this study was to quantify the risk of conversion to open surgery of laparoscopic left hemicolectomy at an early stage of the learning curve. METHODS A multiple logistic regression analysis of 100 laparoscopic left hemicolectomies completed between April 2001 and May 2004 was performed. RESULTS The overall conversion rate was 12%. At univariate analysis, 2 factors were found to be predictive of conversion to open surgery: malignancy (17.2% vs. 5%; P=0.046), and weight level (<60 kg=6.1%; 60 to 90 kg=11.3%; >90 kg=28.6%; P=0.049). At multiple logistic regression, the risk of conversion rose only for patients weighing more than 90 kg. CONCLUSIONS On the basis of the results of this study, the surgeon will be able to quantify the risk of conversion to laparotomy with some precision in order to obtain the informed consent of the first 100 patients to whom laparoscopic left hemicolectomy is proposed.
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Affiliation(s)
- Leopoldo Sarli
- Department of Surgical Sciences, Section of General Surgical Clinics and Surgical Therapy, Parma University Medical School, Parma Hospital, Parma, Italy.
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Abstract
LAC has become an acceptable alternative in the treatment of colon carcinoma. New data should elucidate better the potential advantages in postoperative recovery, QOL, and cost reduction. Appropriate credentialing for LAC remains essential for widespread application of LAC while preserving patient safety.
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Affiliation(s)
- Luca Stocchi
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
Laparoscopic-assisted colectomy (LAC) for colon cancer was first described in 1991. Unlike other laparoscopic procedures used to treat benign disease, the LAC for colon cancer has been slow to gain acceptance for a variety of reasons. Recently, several large, randomized controlled trials have demonstrated that LACs are comparable with open colectomies with respect to oncological issues such as survival, port-site metastases and tumor recurrence. Moreover, there are significant patient benefits with the use of LAC including duration of analgesic use, return of bowel function, length of stay and return to normal activity.
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Affiliation(s)
- Maureen M Tedesco
- Stanford University School of Medicine, Department of Surgery, Stanford, CA 94305-5655, USA
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