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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 Diagn Progn 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chern YJ, Hung HY, You JF, Hsu YJ, Chiang JM, Hsieh PS, Tsai WS. Advantage of laparoscopy surgery for elderly colorectal cancer patients without compromising oncologic outcome. BMC Surg 2020; 20:294. [PMID: 33228630 DOI: 10.1186/s12893-020-00967-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Laparoscopic surgery has achieved significant results in elderly patients with colorectal cancer (CRC). In this study, we compared the short-term and long-term outcomes of open surgery and laparoscopic surgery in patients with CRC aged above 75 years at a single tertiary medical center. Methods We analyzed 967 patients who underwent curative resection for primary colorectal adenocarcinoma without distant metastasis between January 2009 and December 2015, in a single institution. Of the enrolled patients, 305 underwent laparoscopic surgery, and 662 received open laparotomy surgery. Results Compared to the patients who underwent open surgery, those who received laparoscopic surgery had significantly shorter postoperative stay (10.3 vs. 13.5 days p < 0.001) and similar postoperative morbidity (p = 0.354) and mortality (p = 0.082). In the laparoscopy cohort, six of 305 patients were converted to open surgery and one died. The long-term overall survival, cancer-specific survival, and recurrence rate were similar between both cohorts in each stage. Conclusions Laparoscopic surgery is suitable for elderly patients owing to shorter postoperative stay, similar long-term outcomes with open surgery, and acceptable low conversion rates. For long-term overall and oncological outcomes, the results of laparoscopic surgery were similar to that of open surgery in each TNM stage.
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Abstract
PURPOSE OF REVIEW We sought to understand the key aspects to optimize in the perioperative period when treating an elderly surgical patient with inflammatory bowel disease. RECENT FINDINGS Addressing preoperative polypharmacy, frailty, and nutrition is important in the elderly population. Understanding intraoperative principles of oncologic risk and pouch formation and the advantages of laparoscopy are key. Postoperative-enhanced recovery pathways and VTE prophylaxis are essential for high-quality care. Preoperative, perioperative, and postoperative factors can greatly impact elderly patients' surgical outcomes.
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Lirosi MC, Tirelli F, Biondi A, Mele MC, Larotonda C, Lorenzon L, D'Ugo D, Gasbarrini A, Persiani R. Enhanced Recovery Program for Colorectal Surgery: a Focus on Elderly Patients Over 75 Years Old. J Gastrointest Surg 2019; 23:587-94. [PMID: 30187323 DOI: 10.1007/s11605-018-3943-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/20/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND An enhanced recovery after surgery (ERAS) protocol can effectively improve perioperative outcomes in surgical patients by reducing complication rates and hospital stay. However, its application in elderly patients has yielded contradictory results. The aim of this study was to evaluate surgical outcomes in a cohort of elderly patients undergoing colorectal resection in our unit before and after the introduction of ERAS. METHODS From 328 patients undergoing colorectal surgery in our unit over a 2-year period (2015-2016), 114 patients ≥ 75 years of age were selected. The patients were categorized according to perioperative treatment as pre-ERAS and ERAS patients (respectively, 53 vs 61 patients), and the groups were compared for statistical purposes. Outcome measures included length of hospital stay, recovery of bowel functions, oral feeding, postoperative complications, and readmissions. Compliance with the ERAS protocol was also measured. RESULTS Groups were homogeneous for all the clinical-surgical variables, with the sole exception of the Charlson index, which was more severe in the ERAS group (p = 0.012). Compared with control patients, ERAS patients reported improved functional recovery (time to first flatus, stool, and oral feeding; p < 0.001). Hospital stay was reduced in ERAS patients overall and by side of resection, excluding rectal procedures. No differences were observed regarding postoperative complications. Of note, an optimal adherence to the protocol was reported, with 79% of items respected. CONCLUSIONS ERAS can be considered safe in elderly patients undergoing colorectal surgery with a high comorbidity index, providing a reduction in hospital stay and improving short-term postoperative outcomes. Finally, the protocol application was feasible, with a high adherence to the items in this subset of patients.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chern YJ, Tsai WS, Hung HY, Chen JS, Tang R, Chiang JM, Yeh CY, You YT, Hsieh PS, Chiang SF, Lai CC, Lin GP, Hsu YR, You JF. The dark side of laparoscopic surgery for colorectal cancer patients aged 75 years or older. Int J Colorectal Dis 2018; 33:1367-1371. [PMID: 30008115 DOI: 10.1007/s00384-018-3130-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The rate of postoperative morbidity and mortality is reportedly high in patients aged ≥ 75 years with colorectal cancer (CRC). In such patients, a comparison of the short-term outcome between open method and laparoscopy has not been clearly defined in Taiwan. We aimed to compare postoperative morbidity and mortality parameters after open method and laparoscopy in CRC patients aged ≥ 75 years. METHODS We retrospectively analyzed patients who underwent surgery for CRC from February 2009 to September 2015 at the Linkou Chang Gung Memorial Hospital in Taiwan and analyzed their clinicopathological factors. Postoperative morbidity and mortality were analyzed for evaluating if laparoscopic surgery offers more favorable outcomes than open surgery in the elderly. RESULTS A total of 1133 patients were enrolled and analyzed in this study; they were divided into two groups (open method vs. laparoscopy = 797 vs. 336). The anastomotic leakage rate was significantly higher in the laparoscopy group than in the open method group (3.3 vs. 0.9%, p = 0.003). Overall postoperative morbidity and mortality rates showed no significant difference between these two groups. Postoperative hospital stay was significantly shorter in the laparoscopy group than in the open method group (10.4 ± 8.7 vs. 13.8 ± 13.5 days, p < 0.001). CONCLUSIONS Our results suggest that laparoscopy in patients aged ≥ 75 years with CRC had higher anastomosis leakage rate compared with open surgery but is acceptable and offers the benefit of a shorter hospital stay over open surgery.
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Affiliation(s)
- Yih-Jong Chern
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Wen-Sy Tsai
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Hsin-Yuan Hung
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Jinn-Shiun Chen
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Reiping Tang
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Jy-Ming Chiang
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Chien-Yuh Yeh
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Yau-Tong You
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Pao-Shiu Hsieh
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Sum-Fu Chiang
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Cheng-Chou Lai
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Geng-Pin Lin
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Yu-Ren Hsu
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Jeng-Fu You
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Philip S, Jackson N, Mittal V. Outcomes after laparoscopic or robotic colectomy and open colectomy when compared by operative duration for the procedure. Am J Surg 2018. [DOI: 10.1016/j.amjsurg.2017.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Abstract
Introduction Enhanced recovery programmes (ERPs) have been shown to improve short-term outcomes after major colorectal surgery. Benefits of the ERP in patients who are very elderly (VE) are less well understood. We aimed to evaluate the role of the ERP in the VE population, which for the purpose of this study was defined as any patient aged 75 years or over. Methods A prospectively compiled database was used to identify all patients aged ≥75 years who underwent elective colorectal resection in our unit between January 2011 and September 2012. These data were analysed to study the short-term outcomes in these patients and compared with those of patients aged <75 years. Results Overall, 352 patients underwent elective surgery during this period; 106 were identified as VE. The median length of stay (LOS) in the VE group was 7 days (5 days in non-VE group; p=0.002). Two-thirds (62%) underwent laparoscopic surgery. The median LOS of VE patients undergoing laparoscopic surgery was 6 days (11 days for open surgery; p=0.003). A third (33%) of the VE cohort was discharged by day 5. Of these patients, 85% underwent laparoscopic surgery. There was no statistical difference in overall complication rates (VE vs non-VE). Conclusions Accepting that some VE patients may stay in hospital for longer, this study supports our current policy of including everyone in the ERP regardless of age. Patients undergoing laparoscopic surgery appear to benefit, with a shorter LOS. Further large scale trials are required to support the results of this study and to identify long-term outcomes.
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Affiliation(s)
- M A Khan
- Worcestershire Acute Hospitals NHS Trust , UK
| | - S Pandey
- Worcestershire Acute Hospitals NHS Trust , UK
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11
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Kim YW, Kim IY. Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Clin Interv Aging 2016; 11:689-97. [PMID: 27279741 PMCID: PMC4878661 DOI: 10.2147/cia.s104783] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To identify the factors affecting 30-day postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Methods Between 2005 and 2014, a total of 204 consecutive patients aged ≥80 years who underwent major colorectal surgery were included. Results One hundred patients were male (49%) and 52 patients had American Society of Anesthesiologists (ASA) score ≥3 (25%). Combined surgery was performed in 32 patients (16%). Postoperative complications within 30 days after surgery occurred in 54 patients (26%) and 30-day mortality occurred in five patients (2%). Independent risk factors affecting 30-day postoperative complications were older age (≥90 years, hazard ratio [HR] with 95% confidence interval [CI] =4.95 [1.69−14.47], P=0.004), an ASA score ≥3 (HR with 95% CI =4.19 [1.8−9.74], P=0.001), performance of combined surgery (HR with 95% CI =3.1 [1.13−8.46], P=0.028), lower hemoglobin level (<10 g/dL, HR with 95% CI =7.56 [3.07−18.63], P<0.001), and lower albumin level (<3.4 g/dL, HR with 95% CI =3.72 [1.43−9.69], P=0.007). An ASA score ≥3 (HR with 95% CI =2.72 [1.15−6.46], P=0.023), tumor-node-metastasis (TNM) stage IV (HR with 95% CI =3.47 [1.44−8.39], P=0.006), and occurrence of postoperative complications (HR with 95% CI =4.42 [1.39−14.09], P=0.012) were significant prognostic factors for 1-year mortality. Conclusion Patient-related factors (older age, higher ASA score, presence of anemia, and lower serum albumin) and procedure-related factors (performance of combined surgical procedure) increased postoperative complications. Avoidance of 30-day postoperative complications may decrease 1-year mortality.
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Affiliation(s)
- Young Wan Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ik Yong Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kim DH, Kim IY, Kim BR, Kim YW. Factors affecting the selection of minimally invasive surgery for stage 0/I colorectal cancer. Int J Surg 2015; 16:44-48. [PMID: 25749437 DOI: 10.1016/j.ijsu.2015.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate which factors affect selection of minimally invasive surgery (MIS) or open procedures for patients with stage 0/I colorectal cancer. The short-term and oncologic outcomes of MIS were also compared to those of open procedures. METHODS A total of 181 consecutive patients underwent either MIS (laparoscopy: n = 146, robot: n = 8) or open (n = 27) colorectal resection for stage 0/I disease. RESULTS Elderly patients (≥80) were more common in the open procedure group (22.2%) than the MIS (7.8%) group (p = .02). Surgeon A performed more MIS procedures than surgeon B (p = .003). There were no differences in the 30-day complication rate between open (37%) and MIS (21.4%) groups (p = .08). Time to tolerable diet (p = .002) and length of hospital stay (p = .02) were shorter in the MIS group. There were no differences in the cancer-specific survival (p = .71) and recurrence-free survival rates (p = .67) between open and MIS procedures. CONCLUSIONS Patient factors (old age) and surgeon factors (surgeon B) were barriers to the choice of MIS. Old age and operating surgeons were not associated with adverse 30-day complications. The short-term and oncologic outcomes of MIS were comparable to those of open procedures. It is safe to expand the indication for MIS to elderly patients.
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Affiliation(s)
- Dong Hyun Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ik Yong Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Bo Ra Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Wan Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bailey MB, Davenport DL, Vargas HD, Evers BM, McKenzie SP. Longer operative time: deterioration of clinical outcomes of laparoscopic colectomy versus open colectomy. Dis Colon Rectum 2014; 57:616-22. [PMID: 24819102 DOI: 10.1097/DCR.0000000000000114] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND As laparoscopic surgery is applied to colorectal surgery procedures, it becomes imperative to delineate whether there is an operative duration where benefits diminish. OBJECTIVE The purpose of this work was to determine whether benefits of a laparoscopic right colectomy compared with an open right colectomy are diminished by prolonged operative times. DESIGN We performed a retrospective analysis comparing outcomes of patients undergoing laparoscopic right and open right colectomy for colon cancer with operative duration of less than and greater than 3 hours. SETTINGS This study was based on data in the American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS We queried the database for patients with laparoscopic and open right colectomy with a diagnosis of colorectal cancer between 2005 and 2010. MAIN OUTCOME MEASURES Patients were stratified by operative technique and duration. Forward multivariable logistic regression analysis was performed for mortality, cerebrovascular/cardiovascular complications, and infectious complications. Predictors of operative time >3 hours in the laparoscopic cohort were identified by logistic regression. RESULTS Of 4273 patients, operative duration was >3 hours for 18.4% of patients with a laparoscopic right colectomy and 11.3% with an open right colectomy. There was no benefit of the laparoscopic right colectomy with an operative duration >3 hours over open right colectomy with respect to mortality and cardiopulmonary and cerebrovascular complications. An operative duration >3 hours was an independent risk factor for infectious complications in patients undergoing a laparoscopic right colectomy. LIMITATIONS This was a retrospective study and not an intention-to-treat analysis. CONCLUSIONS At an operative duration of ≥3 hours, laparoscopic right colectomy has higher infectious complications than open right colectomy. Reduced mortality and less cardiopulmonary and cerebrovascular complications seen in the laparoscopic cohort with shorter operative duration were lost with an operative duration >3 hours. In patients at risk for prolonged laparoscopic right colectomy, early conversion to an open technique may be warranted.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Vaid S, Tucker J, Bell T, Grim R, Ahuja V. Cost Analysis of Laparoscopic versus Open Colectomy in Patients with Colon Cancer: Results from a Large Nationwide Population Database. Am Surg 2012. [DOI: 10.1177/000313481207800614] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laparoscopic colectomy (LC) is a safe and reliable option for patients with colon cancer. This study examined factors associated with LC use and cost differences between LC and open colectomy (OC). Using the Cost & Utilization Project National Inpatient Sample database (2008), patients with colon cancer undergoing elective LC or OC were selected. Chi square and Mann-Whitney tests were used to assess differences between LC and OC. Logistic and multiple regression analysis was used to determine variables associated with LC and predictors of cost. All analysis was weighted. A total of 63,950 patients were identified (LC 8.1%, OC 91.9%). The majority was female (52.7%), white (61.4%), using Medicare (61.1%), and had surgery performed at a large (64.2%), nonteaching (56.9%), urban (87.3%) hospital in the South (37.7%). Mean age was 70 years. On unadjusted analysis, LC was associated with a lower mortality rate (1.7 vs 2.4%), fewer complications (18.9 vs 27.1%), shorter length of stay (5 vs 7 days), and lower total charges ($41,971 vs $43,459, all P < 0.001). LC is a less expensive but less popular surgical option for colon cancer. Stage, race, Charlson score, teaching status, location, and hospital size influence the use of a laparoscopic approach. LC is associated with fewer complications and decreased mortality which contribute to its lower cost as compared with OC.
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Affiliation(s)
- Sachin Vaid
- Department of Surgery, York Hospital, York, Pennsylvania
| | - James Tucker
- Department of Surgery, York Hospital, York, Pennsylvania
| | - Ted Bell
- Department of Surgery, York Hospital, York, Pennsylvania
| | - Rod Grim
- Department of Surgery, York Hospital, York, Pennsylvania
| | - Vanita Ahuja
- Department of Surgery, York Hospital, York, Pennsylvania
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Pawa N, Cathcart PL, Arulampalam THA, Tutton MG, Motson RW. Enhanced recovery program following colorectal resection in the elderly patient. World J Surg 2012; 36:415-23. [PMID: 22146943 DOI: 10.1007/s00268-011-1328-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The enhanced recovery program (ERP) aims to reduce the metabolic response to surgery, hastening recovery and shortening hospital stay. Concerns exist regarding morbidity and hospital stay in elderly patients. The present study aimed to compare the outcomes and compliance of elderly patients managed by an ERP protocol with a younger group. METHODS A review was performed of a prospective database of patients undergoing colorectal resection managed under the ERP protocol between 2005 and 2010. Patients were grouped into <80 years and ≥ 80 years, and perioperative data were collated. The postoperative outcomes were compared with the goals set out by the ERP protocol. RESULTS A total of 688 patients were included, 558 were <80 years (median: 66 years; range: 17-79 years) and 130 were ≥ 80 years (median: 83 years; range: 80-95 years). Some 96% of operations were planned laparoscopically. Median total length of hospital stay was 6 days (range: 1-108 days) for the <80 year group and 8 days (range: 1-167 days; P 0.363) for the elderly group, with a 30 day readmission rate of 8.6% for the population and no significant differences between groups. The 30 day mortality was 5%, with a significant difference between the two groups (P < 0.0001). Differences in protocol adherence were identified in the discontinuation of intravenous fluids, catheter removal, and early mobilization. CONCLUSIONS An enhanced recovery program is feasible for colorectal surgery patients ≥ 80 years of age, with similar compliance as the younger group to some aspects of the protocol and an acceptable readmission rate. Attention to improving compliance in the postoperative phase is necessary, particularly in such high-risk patients, as such improvement may reduce the morbidity and mortality.
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Affiliation(s)
- Nikhil Pawa
- ICENI Centre, Colchester Hospital University NHS Foundation Trust, Turner Road, Colchester, Essex, CO4 5JL, UK.
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Altuntas YE, Gezen C, Vural S, Okkabaz N, Kement M, Oncel M. 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] [What about the content of this article? (0)] [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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Duron JJ, Duron E, Dugue T, Pujol J, Muscari F, Collet D, Pessaux P, Hay JM. Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 2011; 254:375-82. [PMID: 21772131 DOI: 10.1097/SLA.0b013e318226a959] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify the mortality risk factors of elderly patients (≥65 years old) during major digestive surgery, as defined according to the complexity of the operation. BACKGROUND In the aging populations of developed countries, the incidence rate of major digestive surgery is currently on the rise and is associated with a high mortality rate. Consequently, validated indicators must be developed to improve elderly patients' surgical care and outcomes. METHODS We acquired data from a multicenter prospective cohort that included 3322 consecutive patients undergoing major digestive surgery across 47 different facilities. We assessed 27 pre-, intra-, and postoperative demographic and clinical variables. A multivariate analysis was used to identify the independent risk factors of mortality in elderly patients (n = 1796). Young patients were used as a control group, and the end-point was defined as 30-day postoperative mortality. RESULTS In the entire cohort, postoperative mortality increased significantly among patients aged 65-74 years, and an age ≥65 years was by itself an independent risk factor for mortality (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.36-3.59; P = 0.001). The mortality rate among elderly patients was 10.6%. Six independent risk factors of mortality were characteristic of the elderly patients: age ≥85 years (OR, 2.62; 95% CI, 1.08-6.31; P = 0.032), emergency (OR, 3.42; 95% CI, 1.67-6.99; P = 0.001), anemia (OR, 1.80; 95% CI, 1.02-3.17; P = 0.041), white cell count > 10,000/mm³ (OR, 1.90; 95% CI, 1.08-3.35; P = 0.024), ASA class IV (OR, 9.86; 95% CI, 1.77-54.7; P = 0.009) and a palliative cancer operation (OR, 4.03; 95% CI, 1.99-8.19; P < 0.001). CONCLUSION Characterization of independent validated risk indicators for mortality in elderly patients undergoing major digestive surgery is essential and may lead to an efficient specific workup, which constitutes a necessary step to developing a dedicated score for elderly patients.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 01/06/2010] [Indexed: 12/13/2022]
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da Luz Moreira A, Kiran RP, Kirat HT, Remzi FH, Geisler DP, Church JM, Garofalo T, Fazio VW. Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc 2010; 24:1280-6. [PMID: 20033728 DOI: 10.1007/s00464-009-0761-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 10/12/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND Conceivably, the benefits of earlier recovery associated with a minimally invasive technique used in laparoscopic colectomy (LC) may be amplified for patients with comorbid disease. The dearth of evidence supporting the safety of laparoscopy for these patients led to a comparison of outcomes between LC and open colectomy (OC) for patients with American Society of Anesthesiology (ASA) classifications 3 and 4. METHODS Data for all ASA 3 and 4 patients who underwent elective LC were reviewed from a prospectively maintained laparoscopic database. The patients who underwent LC were matched with OC patients by age, gender, diagnosis, year, and type of surgery. Estimated blood loss, operation time, time to return of bowel function, length of hospital stay, readmission rate, and 30-day complication and mortality rates were compared using chi-square, Fisher's exact, and Wilcoxon tests as appropriate. A p value <0.05 was considered statistically significant. RESULTS In this study, 231 LCs were matched with 231 OCs. The median age of the patients was 68 years, and 234 (51%) of the patients were male. There were 44 (19%) conversions from LC to OC. More patients in the OC group had undergone previous major laparotomy (5 vs. 15%; p < 0.001). Estimated blood loss, return of bowel function, length of hospital stay, and total direct costs were decreased in the LC group. Wound infection was significantly greater with OC (p = 0.02). When patients with previous major laparotomy were excluded, the two groups had similar overall morbidity. The other benefits of LC, however, persisted. CONCLUSION The findings show that LC is a safe option for patients with a high ASA classification. The LC approach is associated with faster postoperative recovery, lower morbidity rates, and lower hospital costs than the OC approach.
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Marks JH, Kawun UB, Hamdan W, Marks G. Redefining contraindications to laparoscopic colorectal resection for high-risk patients. Surg Endosc 2008; 22:1899-904. [DOI: 10.1007/s00464-008-9828-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 01/21/2008] [Accepted: 02/04/2008] [Indexed: 02/03/2023]
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Steele SR, Brown TA, Rush RM, Martin MJ. Laparoscopic vs open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg 2008; 12:583-91. [PMID: 17846852 DOI: 10.1007/s11605-007-0286-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Accepted: 07/29/2007] [Indexed: 01/31/2023]
Abstract
PURPOSE Laparoscopic colectomy has only recently become an accepted technique for the treatment of colon cancer. We sought to analyze factors that affect the type of resection performed and associated outcomes from a large nationwide database. METHODS All admissions with a primary diagnosis of colon cancer undergoing elective resection were selected from the 2003 and 2004 Nationwide Inpatient Samples. Multiple linear and logistic regression analyses were used to compare outcome measures and identify independent predictors of a laparoscopic approach. RESULTS We identified 98,923 admissions (mean age 69.2 years). They were predominately Caucasian (81%), had localized disease (63%), had private insurance (56%), and had surgery performed in urban hospitals (87%). Laparoscopic resection was performed in 3,296 cases (3.3%) and was associated with a lower complication rate (18% vs 22%), shorter length of stay (6 vs 7.6 days), decreased need for skilled aftercare (5% vs 11%), and lower mortality (0.6% vs 1.4%, all P<0.01). There was no significant difference in the total hospital charges between the groups ($34,685 vs $34,178, P=0.19). Independent predictors of undergoing laparoscopic resection were age<70 (odds ratio [OR]=1.2, P<0.01), national region (Midwest OR=1.9, West OR=2.0, P<0.01), and lower disease stage (OR=2.5, P<0.01). Ethnic category and insurance status showed no significant association with operative method (P>0.05). CONCLUSIONS Laparoscopy for colon cancer is associated with improved outcomes in unadjusted analysis and similar charges compared to open resection. We found no influence of race or payer status on the utilization of a laparoscopic approach.
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Affiliation(s)
- Scott R Steele
- Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA.
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Arteaga González I, López-Tomassetti Fernández EM, Hernández Piñero Y, Martín Malagón A, Arranz Durán J, Bethencourt Muñoz S, Díaz H, Carrillo A. Effectiveness of colorectal laparoscopic surgery on patients at high anesthetic risk: an intervention cohort study. Int J Colorectal Dis 2008; 23:101-6. [PMID: 17917734 DOI: 10.1007/s00384-007-0368-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2007] [Indexed: 02/04/2023]
Abstract
AIMS The aim of the study was to assess the effectiveness of laparoscopic colorectal surgery in patients at high preoperative anesthetic risk because of associated pathologies. MATERIALS AND METHODS From January 2003 until January 2005, 116 patients were systematically assigned at a ratio of 1:1 to one of two groups: laparoscopy surgery (n=59, of which 31 were American Society of Anesthesiologists score [ASA] I-II [L1] and 28 ASA III-IV [L2]) or open surgery (n=57, of which 30 were ASA I-II [O1] and 27 ASA III-IV [O2]). Data on patient demographics and clinical and anesthetic variables were collected prospectively. Informed consent was obtained from the patients, and approval was obtained from the designated review board of the institution involved. RESULTS The number of minor anesthetic complications during surgery was higher in L2 patients. No differences were observed in blood gas parameters studied during surgery (pCO(2), pH, and pO(2)/FiO(2)). Transfusion rates in the laparoscopy group at greater anesthetic risk (L2) were lower than those of the high-risk conventional surgery group (O2; 21.4 vs 63%, P<0.02). Duration of stay in the surgical recovery room and the inpatient ward were also shorter in the L2 group than in the O2 group (8.7+/-4.5 vs 12.2+/-6 days, P=0.02). There was no difference in perioperative clinical variables between laparoscopy groups (L1, L2). CONCLUSION Postoperative recovery of ASA III-IV patients is better after laparoscopic surgery for colorectal cancer, at the expense of a higher rate of minor anesthetic occurrences during surgery.
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Abstract
To date, there is little literature regarding the impact of laparoscopic colectomy in the elderly population (i.e., patients older than 70 years) as the vast majority of studies regarding laparoscopic colectomy have evaluated younger patients (younger than 65 years). It is unknown whether elderly patients garner the same benefits from laparoscopic colectomy that younger patients have been shown to receive. As a result, there may be a reluctance to offer laparoscopy to elderly patients. The majority of the reports suggest that laparoscopic colectomy in the elderly is safe and provides the same benefits as laparoscopic colectomy in a younger population. Although an elderly population does not return to the work force, the benefits in the elderly population are related to a return to independence more often than after conventional surgery without an increase in hospital costs. Based on the current literature, one may never be too old to have a laparoscopic colectomy.
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Affiliation(s)
- Matthew G Mutch
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Morales-Conde S, Gómez JC, Cano A, Sánchez-Matamoros I, Valdés J, Díaz M, Pérez A, Bellido J, Fernández P, Pérez R, López J, Martín M, Cantillana J. Ventajas y peculiaridades del abordaje laparoscópico en el anciano. Cir Esp 2005; 78:283-92. [PMID: 16420844 DOI: 10.1016/s0009-739x(05)70937-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Both the age of the population and anesthetic and surgical techniques are advancing. Currently, 40% of surgical activity is performed in patients older than 65 years, who present a higher surgical risk than younger patients. The aim of treatment in the elderly is to provide the best possible quality of life, even though this represents a surgical challenge because of associated comorbidity and reduced cardiopulmonary reserve. From the moment at which laparotomy becomes an increased stress in the elderly, laparoscopic surgery can be particularly advantageous in this population. Therefore, minimally invasive surgery may have a greater impact in these individuals than in younger patients in reducing postoperative pain, cardiorespiratory complications, hospital stay, and recovery time before resuming physical activity. The recent advances in anesthesia, together with improved patient selection and perioperative cardiac care, and the general adoption of minimally invasive access have enabled more complex gastrointestinal procedures to be performed in the elderly. The factors that could influence the development of this type of approach in the elderly, as well as the precautions that should be taken, should be further analyzed.
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Affiliation(s)
- S Morales-Conde
- Unidad de Cirugía Laparoscópica, Servicio de Cirugía General y Digestiva I. Hospital Universitario Virgen Macarena, Sevilla, España.
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29
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Abstract
The dramatic increase in digestive surgery among patients of advanced age is the logical consequence of the aging population demographics in developed countries. Surgery in the aged is not fundamentally different, but it demands precise and tailored assessment and management of surgical indications and surgical and anesthetic techniques. Advanced age is not a contraindication to even major digestive surgery, but every effort must be made to avoid urgent operations by attention to pre-existing symptoms which are all-too-often neglected in the aged. Intensive care may help to shorten the hospital stay which should ideally occupy only a minor portion of the numbered days of the patient (whose life expectancy may be significantly longer than one may intuitively foresee).
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Affiliation(s)
- J J Duron
- Service de Chirurgie Générale, Hôpital de la Pitié Salpetrière, Paris.
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30
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Abstract
BACKGROUND Bowel injury is a rare but serious complication of laparoscopic surgery. This review examines the incidence, location, time of diagnosis, causative instruments, management and mortality of laparoscopy-induced bowel injury. METHODS The review was carried out using the MeSH browser within PubMed. The keywords used were 'laparoscopy/adverse effects' and 'bowel perforation'. Additional articles were sourced from references within the studies found in the PubMed search. RESULTS The incidence of laparoscopy-induced gastrointestinal injury was 0.13 per cent (430 of 329 935) and of bowel perforation 0.22 per cent (66 of 29 532). The small intestine was most frequently injured (55.8 per cent), followed by the large intestine (38.6 per cent). In at least 66.8 per cent of bowel injuries the diagnosis was made during the laparoscopy or within 24 h thereafter. A trocar or Veress needle caused the most bowel injuries (41.8 per cent), followed by a coagulator or laser (25.6 per cent). In 68.9 per cent of instances of bowel injury, adhesions or a previous laparotomy were noted. Management was mainly by laparotomy (78.6 per cent). The mortality rate associated with laparoscopy-induced bowel injury was 3.6 per cent. CONCLUSION At 0.13 per cent, the incidence of laparoscopy-induced bowel injury is small and such injury is usually discovered during the operation. Nevertheless, laparoscopy-induced bowel injury is associated with a high mortality rate of 3.6 per cent.
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Affiliation(s)
- M van der Voort
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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31
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Ceulemans R, Al-Ahdab N, Leroy J, Garcia A, Dutson E, Rubino F, Simone M, Mutter D, Marescaux J. Safe laparoscopic surgery in the elderly. Am J Surg 2004; 187:323-7. [PMID: 15006558 DOI: 10.1016/j.amjsurg.2003.12.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Revised: 08/11/2003] [Indexed: 11/23/2022]
Abstract
BACKGROUND The elderly are more prone to complications of surgery because of comorbidity, and they may benefit most from a minimally invasive approach. This study was intended to evaluate the safety of the use of a laparoscopic approach for emergency and elective surgery in elderly patients. METHODS From January 2000 to June 2001, all patients over 75 years of age who underwent a procedure that began laparoscopically were included. Physiologic and operative scores according to the POSSUM scoring system were recorded. These were then used to calculate predicted morbidity and mortality by both the POSSUM and P-POSSUM systems. Predicted outcomes were compared with actual outcomes. RESULTS One hundred sixty-two patients with a mean age of 80 years were included; 52% were emergency cases. The overall morbidity was 14.5% and the mortality rate was 1.8%. Fourteen procedures (8.4%), all emergencies, were converted. Both mortality and morbidity rates were lower than the predicted values (P = 0.001 and P = 0.0001, respectively). CONCLUSIONS A laparoscopic approach can be used safely in an elderly population undergoing surgery in a daily practice for miscellaneous conditions, whether elective or emergency operations.
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Affiliation(s)
- Robrecht Ceulemans
- IRCAD/EITS, European Institute of Telesurgery, University Louis Pasteur, 1, Place de l'Hôpital, 67091 Strasbourg, France.
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32
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33
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Yamamoto S, Watanabe M, Hasegawa H, Baba H, Kitajima M. Short-term surgical outcomes of laparoscopic colonic surgery in octogenarians: a matched case-control study. Surg Laparosc Endosc Percutan Tech 2003; 13:95-100. [PMID: 12709614 DOI: 10.1097/00129689-200304000-00007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was undertaken to evaluate the short-term surgical outcomes of laparoscopic surgery for colonic carcinoma in octogenarians and compare them with those for a younger group of patients who underwent the same surgical procedures. This matched case-control study involved 17 octogenarian patients with colonic carcinoma who underwent laparoscopic surgery between 1996 and 2001. The results were compared with those for 34 matched patients aged 60 years or less who underwent the same surgical procedures during the same period. Both groups were well matched for clinical characteristics. However, the American Society of Anesthesiology status was significantly higher in the octogenarian group (P = 0.001). There were no significant differences between the two groups in terms of the incidence of complications, the interval before resumption of liquid or solid food intake, or length of hospitalization. There were no deaths in either group. Advanced age should not be regarded as a contraindication for laparoscopic colonic surgery.
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