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Yoshimatsu K, Kono T, Ito Y, Satake M, Yamada Y, Okayama S, Yokomizo H, Shiozawa S. Laparoscopic Surgery Reduces Risk of Postoperative Complications and Non Cancer-related Survival in Patients Over 80 Years Old With Colorectal Cancer. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:297-301. [PMID: 35403147 PMCID: PMC8988957 DOI: 10.21873/cdp.10039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The short- and long-term results from several reports suggest that laparoscopic surgery (LAP) for elderly patients is expected to reduce the risk of complications due to its minimal invasiveness, However, little is known about the effect of LAP on long-term prognosis aside from cancer. PATIENTS AND METHODS Eighty-five cases over 80 years old with colorectal cancer whose primary lesions were resected consecutively were enrolled. Risk factors for complications were searched using categorized clinicopathological factors. The factors for death unrelated to cancer were analyzed in patients by excluding cancer-related death. RESULTS Incidence of all complications, those of Clavien-Dindo grade 2 or more, and surgical site infection were significantly lower in LAP-treated patients (p=0.0343, p=0.0015 and p=0.0015, respectively). By multivariate analysis, LAP (odds ratio=0.19, 95% confidence intervaI=0.05-0.75, p=0.0177) and no pulmonary dysfunction (odds ratio=0.24, 95% confidence intervaI=0.06-0.96, p=0.0441) were significantly associated with reduced risk of complications of Clavien-Dindo grade 2 or more. LAP, no pulmonary dysfunction and Eastern Cooperative Oncology Group performance status of 0 or 1 were also significantly associated with reduced risk for death from non cancer-related causes. Additionally, LAP was significantly associated with improved survival excluding cancer-related death in patients with pulmonary dysfunction (p=0.0020) or with poor performance status (p=0.0412). CONCLUSION These results suggest that fewer complications and non cancer-related deaths were achieved in very elderly patients with colorectal cancer when treated by LAP.
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Affiliation(s)
| | - Teppei Kono
- Department of Surgery, Saitamaken Saiseikai Kurihashi Hospital, Kuki, Japan
| | - Yoshitomo Ito
- Department of Surgery, Saitamaken Saiseikai Kurihashi Hospital, Kuki, Japan
| | - Masaya Satake
- Department of Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Yasufumi Yamada
- Department of Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Sachiyo Okayama
- Department of Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Hajime Yokomizo
- Department of Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Shunichi Shiozawa
- Department of Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
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Hashimoto S, Hamada K, Sumida Y, Araki M, Wakata K, Kugiyama T, Shibuya A, Nishimuta M, Morino S, Baba M, Kiya S, Ozeki K, Nakamura A. Short- and long-term survival after curative resection for colorectal cancer in nonagenarian patients. Asian J Surg 2021; 45:208-212. [PMID: 34049788 DOI: 10.1016/j.asjsur.2021.04.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/OBJECTIVE With increased life expectancy, the incidence of colorectal cancer in oldest-old patients has been rising. Advanced age is a risk factor for adverse outcomes after surgery. This study aimed to evaluate the short- and long-term outcomes of curative resection for colorectal cancer in nonagenarians. METHODS Patients who had undergone curative resection for colorectal cancer (CRC) at Stage I to III from January 2010 to December 2019 were included. Cases of emergent surgery were excluded. The clinical characteristics were documented retrospectively, and factors affecting the long-term outcome were analyzed using multivariate analysis. RESULTS Fifty patients met the selection criteria. Most of them were women (58.0%), and the median age was 92 years. Among these patients, 29 (58.0%) had a poor performance status (ASA-PS≥3). Laparoscopic surgery was performed in 42.0% of the patients, and 50% of the patients had postoperative complications classified as Clavien-Dindo grade 2 or severer, including 3 patients (6.0%) with grade 3 disease. No postoperative mortality occurred. The 30-day, 180-day, 1-year, 3-year and 5-year survival rates were 100%, 80.4%, 71.0%, 46.3%, and 33.8%, respectively. Multivariate analysis showed that a preoperative poor performance status (ASA-PS≥3) (HR: 3.067; 95% CI: 1.220-7.709; p = 0.017) was an independent prognostic factor for OS. CONCLUSION Curative elective resections for CRC in nonagenarians were performed safely without postoperative mortality. The preoperative performance status was significantly associated with OS after curative elective resection of colorectal cancer in nonagenarians. Our results suggest that excellent long-term outcomes can be achieved in a selected group with a good performance status.
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Affiliation(s)
| | - Kiyoaki Hamada
- Department of Surgery, Sasebo City General Hospital, Japan.
| | | | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, Japan
| | - Kouki Wakata
- Department of Surgery, Sasebo City General Hospital, Japan
| | - Tota Kugiyama
- Department of Surgery, Sasebo City General Hospital, Japan
| | - Ayako Shibuya
- Department of Surgery, Sasebo City General Hospital, Japan
| | | | | | - Masayuki Baba
- Department of Surgery, Sasebo City General Hospital, Japan
| | - Soichiro Kiya
- Department of Surgery, Sasebo City General Hospital, Japan
| | - Keisuke Ozeki
- Department of Surgery, Sasebo City General Hospital, Japan
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Tecos ME, Kern BS, Foje NA, Leif ML, Schmidt M, Steinberger A, Bajinting A, Buesing KL. Perioperative considerations in nonagenarians. Surg Open Sci 2020; 2:45-49. [PMID: 33073225 PMCID: PMC7545003 DOI: 10.1016/j.sopen.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The nation's aging population presents novel perioperative challenges. Potential benefits of operative interventions must be scrutinized in relation to recoverable quality of life. The purpose of this study is to evaluate common risk calculators used for medical decision making in a nonagenarian patient population. METHODS Retrospective medical record review was performed on patients 90 years or older who underwent operative interventions requiring anesthesia at a large academic medical center between January 1, 2013, and December 31, 2017. GraphPad 8.2.1 was used for statistical analysis. RESULTS Significant differences were found when data were stratified by age for elective versus emergent cases (P value < .0001), ability to return to baseline function (P value = .0062), and mortality (P value < .0001). Significant differences were found in emergent and elective cases, ability to return to baseline function, readmissions, and mortality (all P values < .0001) when stratified by American Society of Anesthesiologists score. Ability of patients to return to baseline functionality after intervention was influenced by their preintervention level of functionality (P value = .0008). American College of Surgeons and Portsmouth Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity risk calculators underestimated the need for rehabilitation and overestimated mortality for this population (all P values < .0001). CONCLUSION Perioperative cares of the extreme geriatric population are complex and should be approached collaboratively. Rehabilitation and postoperative assistance resources should be assessed and used fully. Input from palliative care teams should be sought appropriately. End-of-life and escalation-of-care discussions should ideally be organized prior to emergent interventions. Frailty and risk calculators should be used and considered for formal implementation into the preoperative workflow.
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Affiliation(s)
- Maria E. Tecos
- University of Nebraska Medical Center, Department of Surgery, Omaha, NE
| | - Brittany S. Kern
- Spectrum Health Michigan State University, Department of Surgery, Grand Rapids, MI
- Baystate Medical Center Department of Surgery, Hanover, MD
| | - Nathan A. Foje
- University of Nebraska Medical Center, Department of Surgery, Omaha, NE
- University of Nebraska Medical Center, College of Medicine, Omaha, NE
| | - Marilyn L. Leif
- University of Nebraska Medical Center, College of Medicine, Omaha, NE
| | - Mitchell Schmidt
- Washington University in St. Louis, Department of Surgery, St. Louis, MO
- St. Louis University, School of Medicine, St. Louis, MO
| | | | | | - Keely L. Buesing
- University of Nebraska Medical Center, Department of Surgery, Omaha, NE
- University of Nebraska Medical Center, College of Medicine, Omaha, NE
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4
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Roque-Castellano C, Fariña-Castro R, Nogués-Ramia EM, Artiles-Armas M, Marchena-Gómez J. Colorectal cancer surgery in selected nonagenarians is relatively safe and it is associated with a good long-term survival: an observational study. World J Surg Oncol 2020; 18:120. [PMID: 32493351 PMCID: PMC7271489 DOI: 10.1186/s12957-020-01895-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background Advanced age is a risk factor for colorectal cancer, and very elderly patients often need to be surgically treated. This study aimed to analyze the outcomes of a cohort of nonagenarian patients operated on for colorectal cancer. Methods Observational study conducted on a cohort of 40 nonagenarian patients, who were treated surgically for colorectal cancer between 2000 and 2018 in our institution. Clinical data, ASA score, Charlson Comorbidity Index, Surgical Mortality Probability Model, tumor characteristics, and nature and technical features of the surgical procedure, were recorded. The Comprehensive Complication Index (CCI) and survival time after the procedure were recorded as outcome variables. Univariate and multivariate analyses were performed in order to define risk factors for postoperative complications and long-term survival. Results Out of the 40 patients, 13 (32.5%) were men, 27 (67.5%) women, and mean age 91.6 years (SD ± 1.5). In 24 patients (60%), surgery was elective, and in 16 patients (40%), surgery was emergent. Curative surgery with intestinal resection was performed in 34 patients (85%). In 22 patients (55%), intestinal continuity was restored by performing an anastomosis. The median CCI was 22.6 (IRQ 0.0–42.6). Operative mortality was 10% (4 patients). Cumulative survival at 1, 3, and 5 years was 70%, 47%, and 29%, respectively. In multivariate analysis, only the need for transfusion remained as an independent prognostic factor for complications (p = 0.021) and TNM tumor stage as a significant predictor of survival (HR 3.0, CI95% 1.3–7.2). Conclusions Colorectal cancer surgery is relatively safe in selected nonagenarian patients and may achieve long-term survival.
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Affiliation(s)
- Cristina Roque-Castellano
- Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Roberto Fariña-Castro
- Department of Anesthesiology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva María Nogués-Ramia
- Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Manuel Artiles-Armas
- Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Joaquín Marchena-Gómez
- Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. .,Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
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Franco I, de'Angelis N, Canoui-Poitrine F, Le Roy B, Courtot L, Voron T, Aprodu R, Salamé E, Saleh NB, Berger A, Ouaïssi M, Altomare DF, Pezet D, Mutter D, Brunetti F, Memeo R. Feasibility and Safety of Laparoscopic Right Colectomy in Oldest-Old Patients with Colon Cancer: Results of the CLIMHET Study Group. J Laparoendosc Adv Surg Tech A 2018; 28:1326-1333. [PMID: 30256131 DOI: 10.1089/lap.2018.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laparoscopy for colorectal cancer treatment is widely accepted. However, there is no consensus as to whether or not laparoscopy can be considered the preferred treatment strategy in octogenarian and nonagenarian patients with colon cancer. The aim of this study was to compare operative and postoperative outcomes of laparoscopic right colectomy between oldest-old (≥80 years) and younger (<80 years) patients with colon cancer. METHODS The study population was sampled from the CLIMHET Study Group cohort. Between January 2005 and December 2015, data were retrieved for all patients who had undergone elective laparoscopic right colectomy for colon cancer in five University Hospital centers in France (CHU of Clermont-Ferrand, Hôpital Civil of Strasbourg-IRCAD, Hôpital Henri-Mondor of Créteil, Hôpital Européen Georges Pompidou of Paris, and CHRU of Tours). RESULTS Overall, 473 cancer patients were selected and analyzed. There were 156 oldest-old patients (median age: 84.1 years, range: 80-96) and 317 younger patients (median age: 67 years, range: 25-79). After adjusting based on propensity score on gender, obesity, American Society of Anesthesiologists score, smoking, arteriopathy, coronaropathy, comorbidity, and American Joint Committee on Cancer staging, no significant difference was found in operative and postoperative outcomes, except for time to resume a regular diet (3.6 days versus 3.0 days, P = .008) and length of hospital stay (12.1 days versus 9.1 days, P = .03), which were longer for oldest-old patients. Overall and disease-free survival rates were also equivalent between groups. CONCLUSION These findings support that laparoscopic right colectomy can be safely performed in cancer patients aged 80 and older, and its outcomes are similar in oldest-old and younger patients.
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Affiliation(s)
- Ilaria Franco
- 1 Department of Emergency and Organ Transplantation, Azienda Ospedaliero-Universitaria , Bari, Italy .,2 Hepato-Biliary and Pancreatic Surgical Unit, IRCAD-IHU, Place de l'Hôpital, University of Strasbourg , Strasbourg, France
| | - Nicola de'Angelis
- 3 Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri-Mondor Hospital , AP-HP, Créteil, France
| | - Florence Canoui-Poitrine
- 4 Biostatistics Department, Henri Mondor Hospital , Assistance Publique Hôpitaux de Paris, Créteil, France .,5 CEpiA EA7376, DHU Ageing-Thorax-Vessel-Blood, Université Paris Est (UPEC) , Créteil, France
| | - Bertrand Le Roy
- 6 Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive , Clermont-Ferrand, France
| | - Lise Courtot
- 7 Service de Chirurgie Digestive, Endocrinienne, Oncologique et Transplantation Hépatique , CHRU, Tours, France
| | - Thibault Voron
- 8 Service de Chirurgie Générale , Digestive et Oncologique, Hôpital Européen George Pompidou, AP-HP, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Razvan Aprodu
- 8 Service de Chirurgie Générale , Digestive et Oncologique, Hôpital Européen George Pompidou, AP-HP, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Ephrem Salamé
- 7 Service de Chirurgie Digestive, Endocrinienne, Oncologique et Transplantation Hépatique , CHRU, Tours, France
| | - Nour Bou Saleh
- 6 Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive , Clermont-Ferrand, France
| | - Anne Berger
- 8 Service de Chirurgie Générale , Digestive et Oncologique, Hôpital Européen George Pompidou, AP-HP, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Mehdi Ouaïssi
- 7 Service de Chirurgie Digestive, Endocrinienne, Oncologique et Transplantation Hépatique , CHRU, Tours, France
| | - Donato Francesco Altomare
- 1 Department of Emergency and Organ Transplantation, Azienda Ospedaliero-Universitaria , Bari, Italy
| | - Denis Pezet
- 6 Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive , Clermont-Ferrand, France
| | - Didier Mutter
- 2 Hepato-Biliary and Pancreatic Surgical Unit, IRCAD-IHU, Place de l'Hôpital, University of Strasbourg , Strasbourg, France
| | - Francesco Brunetti
- 3 Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri-Mondor Hospital , AP-HP, Créteil, France
| | - Riccardo Memeo
- 1 Department of Emergency and Organ Transplantation, Azienda Ospedaliero-Universitaria , Bari, Italy .,2 Hepato-Biliary and Pancreatic Surgical Unit, IRCAD-IHU, Place de l'Hôpital, University of Strasbourg , Strasbourg, France .,9 Department of General Surgery, Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
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6
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Nagai Y, Togo N, Nakagi M, Takai S, Tanaka M, Yasuoka H, Tatsumi T. Successful laparoscopic treatment of advanced rectal cancer in an extremely elderly man (101 years and 9 months). Asian J Endosc Surg 2018; 11:50-52. [PMID: 28703507 DOI: 10.1111/ases.12406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/12/2017] [Accepted: 05/30/2017] [Indexed: 12/31/2022]
Abstract
An extremely elderly man (age, 101 years and 9 months) visited our hospital because of recurrent and worsening anal bleeding. Type 2 rectal cancer was found in his rectum during colonoscopy. He did not have any severe coexisting diseases and had not suffered any episodes of dementia. Laparoscopy-assisted anterior resection combined with D2 lymph node dissection was performed with minimal bleeding. The operation time was 128 min. The patient suffered mild reflux pneumonia on postoperative day 6 and was administered additional antibiotics. He recovered within 2 days. He was discharged on postoperative day 17, at which point he was able to walk.
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Affiliation(s)
- Yugo Nagai
- Department of Surgical Endoscopy, Medical Corporation for Saving Your Life (McSYL) Tatsumi Clinic and Hospital, Ikeda, Japan
| | - Naoki Togo
- Department of Surgical Endoscopy, Medical Corporation for Saving Your Life (McSYL) Tatsumi Clinic and Hospital, Ikeda, Japan
| | - Masafumi Nakagi
- Department of Surgical Endoscopy, Medical Corporation for Saving Your Life (McSYL) Tatsumi Clinic and Hospital, Ikeda, Japan
| | - Soichiro Takai
- Department of Surgery, Tatsumi Imamiya Hospital, Minoh, Japan
| | - Masaya Tanaka
- Department of Internal Medicine, Medical Corporation for Saving Your Life (McSYL) Tatsumi Clinic and Hospital, Ikeda, Japan
| | - Hidetaka Yasuoka
- Department of Internal Medicine, Medical Corporation for Saving Your Life (McSYL) Tatsumi Clinic and Hospital, Ikeda, Japan
| | - Takahiko Tatsumi
- Department of Internal Medicine, Medical Corporation for Saving Your Life (McSYL) Tatsumi Clinic and Hospital, Ikeda, Japan
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7
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Schlichtemeier S, Logaraj A, Gill AJ, Engel A. Colorectal cancer resection in the Australian nonagenarian patient. Colorectal Dis 2017; 19:243-250. [PMID: 27354302 DOI: 10.1111/codi.13434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/11/2016] [Indexed: 12/22/2022]
Abstract
AIM The nonagenarian population is a rapidly growing segment of the Australian population. Surgical resection continues to offer the best chance of long-term survival in colorectal cancer. The primary aims of the present study were to evaluate the 30-day mortality and survival of Australian patients ≥ 90 years of age undergoing surgical resection for colorectal cancer in our health service. The secondary aims were to examine the clinicopathological characteristics of the patients and their tumours. METHOD All patients ≥ 90 years of age undergoing surgical resection for colorectal cancer from 1998 to 2012 were identified in a centralized multihospital database. Key clinicopathological data, 30-day mortality and long-term overall survival were recorded for each patient. RESULTS There were 121 patients identified of median age 91 years, 74% of whom were female. The median tumour size was 40 mm, and 51% of operations were carried out as an emergency. The TNM stage was Stage I/II in 57%, Stage III in 40% and Stage IV in 3%. The 30-day mortality was 6.6% (eight of 121) and the 1-, 3- and 5-year overall survival rates were 82.6%, 50.2% and 32.3%, respectively. CONCLUSION Surgical resection in the nonagenarian patient has an acceptable mortality and offers good overall survival.
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Affiliation(s)
- S Schlichtemeier
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - A Logaraj
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - A J Gill
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Anatomical Pathology, Royal North Shore Hospital and Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - A Engel
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Healthy Ageing and Sydney Vital Translational Cancer Research, Kolling Institute of Medical Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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8
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Landi F, Vallribera F, Rivera JP, Bertoli P, Armengol M, Espín E. Morbidity after laparoscopic and open rectal cancer surgery: a comparative analysis of morbidity in octogenarians and younger patients. Colorectal Dis 2016; 18:459-67. [PMID: 26408287 DOI: 10.1111/codi.13136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/10/2015] [Indexed: 12/25/2022]
Abstract
AIM Although the oncological adequacy of laparoscopic rectal resection (LR) appears equivalent to open resection (OR), its benefit is controversial in the elderly. The aim of this study was to investigate the influence of LR on morbidity and mortality in octogenarians. METHOD This was a retrospective analysis of all patients who underwent rectal surgery for cancer between 2003 and 2013 in a teaching hospital. The primary aim of the study was to assess the influence of surgical approach on mortality and morbidity of rectal resection in patients ≥ 80 years old. Regression analysis was performed to control the effect of covariables on the clinical outcome. RESULTS Of 408 patients 203 were in the LR group and 205 in the OR group including 303 (74.3%) less than 80 years and 105 (25.7%) over 80 years. The mortality was lower in the LR group compared with the OR group for patients under 80 years (0% vs 4.6%; P = 0.049) and no different in the over 80 group (11.5% vs 9.4%; P = 0.859). In younger patients, the OR group showed longer hospital stay (9 vs 7 days; P < 0.001) and more complications (44.1% vs 29.8%; P = 0.042). Medical complications were more frequent in LR group than OR group octogenarians (40.4% vs 20.8%; P = 0.009) as well as grade C anastomotic leakage (13.8 vs 10.7; P = 0.041). CONCLUSION LR for rectal cancer showed clinical advantages in patients under 80 years and was as safe as OR in patients over 80 years, although the advantages of laparoscopic surgery were lost in the elderly group due to a higher rate of medical complications. OR may be an option in elderly patients with important comorbidities.
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Affiliation(s)
- F Landi
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - F Vallribera
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - J P Rivera
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - P Bertoli
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - M Armengol
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - E Espín
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,Universidad Autonoma de Barcelona, Barcelona, Spain
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9
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Li Y, Wang S, Gao S, Yang C, Yang W, Guo S. Laparoscopic colorectal resection versus open colorectal resection in octogenarians: a systematic review and meta-analysis of safety and efficacy. Tech Coloproctol 2016; 20:153-62. [PMID: 26783029 DOI: 10.1007/s10151-015-1419-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 12/25/2015] [Indexed: 01/01/2023]
Abstract
Octogenarians are more often viewed as high-risk surgical candidates. This increased risk is attributed to an age-related decline in physical function and reserve capacity coupled with the presence of various underlying diseases. There are no current guidelines or consensus on the optimal treatment strategy for this cohort of complex patients. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of laparoscopic colorectal resection versus open colorectal resection in octogenarians. The meta-analysis was conducted following all aspects of the Cochrane Handbook for Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic literature review was carried out using the following databases: MEDLINE, Embase, PubMed, the Cochrane Library, Google Scholar and OVID. Only studies comparing outcome of laparoscopic and open colorectal resections in the elderly population (≥80 years) were selected. The data collected included the patient demographics, interventions, observed outcome and sources of bias. When performing the statistical analysis, we used the odds ratio for categorical variables and the weighted mean difference for continuous variables. The results of this systematic review and pooled analysis demonstrated the safety and potential benefits of laparoscopic colorectal resection in octogenarians. LC can reduce the length of hospital stay, intraoperative blood loss, time to return of normal bowel function, and incidence of postoperative pneumonia, wound infection, and postoperative ileus.
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Affiliation(s)
- Y Li
- Department of Colorectal Surgery, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China.
| | - S Wang
- The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Medical University, No. 56 Xinjian Road South, Taiyuan, Shanxi, 030001, China
| | - S Gao
- Department of Colorectal Surgery, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China
| | - C Yang
- The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Medical University, No. 56 Xinjian Road South, Taiyuan, Shanxi, 030001, China
| | - W Yang
- Department of Gastroenterology, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China
| | - S Guo
- Department of Molecular Biology, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China
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