Efficacy and safety of laparoscopic surgery in elderly patients with colorectal cancer

Inoue,Yasuhiro; Kawamoto,Aya; Okugawa,Yoshinaga; Hiro,Junichiro; Saigusa,Susumu; Toiyama,Yuji; Araki,Toshimitsu; Tanaka,Koji; Mohri,Yasuhiko; Kusunoki,Masato

doi:10.3892/mco.2015.530

Efficacy and safety of laparoscopic surgery in elderly patients with colorectal cancer

Authors:
- Yasuhiro Inoue
- Aya Kawamoto
- Yoshinaga Okugawa
- Junichiro Hiro
- Susumu Saigusa
- Yuji Toiyama
- Toshimitsu Araki
- Koji Tanaka
- Yasuhiko Mohri
- Masato Kusunoki
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Affiliations: Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514‑8507, Japan
Published online on: March 30, 2015 https://doi.org/10.3892/mco.2015.530
Pages: 897-901

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Abstract

Colorectal cancer (CRC) is predominantly a disease of the elderly. Elderly patients may also exhibit poorer outcomes due to the increased burden of comorbidities, functional dependency and limited life expectancy. The aim of this study was to evaluate the outcome of laparoscopic surgery in elderly patients with CRC. A total of 148 patients who underwent laparoscopic surgery at our institution between January, 2000 and December, 2011 were enrolled. We compared the differences between elderly patients (aged >75 years, n=48) and non‑elderly patients (aged <75 years, n=100) and evaluated the demographics and disease‑related operative and prognostic data. Postoperative complications occurred in 24 (16.2%) of the 148 patients. The American Society of Anesthesiologists score and comorbidity were found to be significantly correlated with complications and the multivariate analysis demonstrated that pulmonary disease, but not age, was an independent factor affecting postoperative complications (odds ratio = 3.21, 95% confidence interval: 1.02‑10.14, P=0.0470). Patients with pulmonary comorbidities also exhibited similar rates of postoperative complications compared with 259 matched patients who underwent open surgery during same period (41.2 vs. 46.7%, respectively; P=0.7547). In conclusion, chronological age alone should not be considered a contraindication for laparoscopic surgery for CRC in elderly patients. In addition, selection criteria for laparoscopic CRC surgery in elderly as well as non‑elderly patients should include pulmonary comorbidities.

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1	Köhne CH, Folprecht G, Goldberg RM, Mitry E and Rougier P: Chemotherapy in elderly patients with colorectal cancer. Oncologist. 13:390–402. 2008. View Article : Google Scholar : PubMed/NCBI
2	Yang L, Parkin DM, Li LD, Chen YD and Bray F: Estimation and projection of the national profile of cancer mortality in China: 1991–2005. Br J Cancer. 90:2157–2166. 2004.PubMed/NCBI
3	Boyle P and Ferlay J: Cancer incidence and mortality in Europe, 2004. Ann Oncol. 16:481–488. 2005. View Article : Google Scholar : PubMed/NCBI
4	Christensen K, Doblhammer G, Rau R and Vaupel JW: Ageing populations: The challenges ahead. Lancet. 374:1196–1208. 2009. View Article : Google Scholar : PubMed/NCBI
5	Sanoff HK, Bleiberg H and Goldberg RM: Managing older patients with colorectal cancer. J Clin Oncol. 25:1891–1897. 2007. View Article : Google Scholar : PubMed/NCBI
6	Clinical Outcomes of Surgical Therapy Study Group: A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 350:2050–2059. 2004. View Article : Google Scholar : PubMed/NCBI
7	Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM and Brown JM: MRC CLASICC trial group: Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): Multicentre, randomised controlled trial. Lancet. 365:1718–1726. 2005. View Article : Google Scholar : PubMed/NCBI
8	Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, Smith JS, Solomon MJ, Stephens JH and Stevenson AR: Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: The ALCCaS trial. Ann Surg. 248:728–738. 2008. View Article : Google Scholar : PubMed/NCBI
9	Simmonds PD, Best L, George S, Baughan C, Buchanan R, Davis C, Fentiman I, Gosney M, Northover J and Williams C: Colorectal Cancer Collaborative Group: Surgery for colorectal cancer in elderly patients: A systematic review. Lancet. 356:968–974. 2000. View Article : Google Scholar : PubMed/NCBI
10	Delgado S, Lacy AM, García Valdecasas JC, Balagué C, Pera M, Salvador L, Momblan D and Visa J: Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc. 14:22–26. 2000. View Article : Google Scholar : PubMed/NCBI
11	Sklow B, Read T, Birnbaum E, Fry R and Fleshman J: Age and type of procedure influence the choice of patients for laparoscopic colectomy. Surg Endosc. 17:923–929. 2003. View Article : Google Scholar : PubMed/NCBI
12	Frasson M, Braga M, Vignali A, Zuliani W and Di Carlo V: Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum. 51:296–300. 2008. View Article : Google Scholar : PubMed/NCBI
13	Tomimaru Y, Ide Y and Murata K: Outcome of laparoscopic surgery for colon cancer in elderly patients. Asian J Endosc Surg. 4:1–6. 2011. View Article : Google Scholar : PubMed/NCBI
14	She WH, Poon JT, Fan JK, Lo OS and Law WL: Outcome of laparoscopic colectomy for cancer in elderly patients. Surg Endosc. 27:308–312. 2013. View Article : Google Scholar : PubMed/NCBI
15	Charlson ME, Pompei P, Ales KL and MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 40:373–383. 1987. View Article : Google Scholar : PubMed/NCBI
16	Endoh H, Yamamoto R, Satoh Y, Kuwano H and Nishizawa N: Risk analysis of pulmonary resection for elderly patients with lung cancer. Surg Today. 43:514–520. 2013. View Article : Google Scholar : PubMed/NCBI
17	Akiyoshi S, Mimori K, Sudo T, Tanaka F, Shibata K and Mori M: Laparoscopic surgery minimizes the surgical manipulation of isolated tumor cells leading to decreased metastasis compared to open surgery for colorectal cancer. Surg Today. 43:20–25. 2013. View Article : Google Scholar : PubMed/NCBI
18	Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A and Pique JM: The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg. 248:1–7. 2008. View Article : Google Scholar : PubMed/NCBI
19	Hiki N, Shimizu N, Yamaguchi H, Imamura K, Kami K, Kubota K and Kaminishi M: Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg. 93:195–204. 2006. View Article : Google Scholar : PubMed/NCBI
20	Tsamis D, Theodoropoulos G, Stamopoulos P, Siakavellas S, Delistathi T, Michalopoulos NV and Zografos GC: Systemic inflammatory response after laparoscopic and conventional colectomy for cancer: A matched case-control study. Surg Endosc. 26:1436–1443. 2012. View Article : Google Scholar : PubMed/NCBI
21	Han SA, Lee WY, Park CM, Yun SH and Chun HK: Comparison of immunologic outcomes of laparoscopic vs open approaches in clinical stage III colorectal cancer. Int J Colorectal Dis. 25:631–638. 2010. View Article : Google Scholar : PubMed/NCBI
22	Huang C, Huang R, Jiang T, Huang K, Cao J and Qiu Z: Laparoscopic and open resection for colorectal cancer: An evaluation of cellular immunity. BMC Gastroenterol. 10:1272010. View Article : Google Scholar : PubMed/NCBI
23	Grailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P and Faiz O: Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc. 27:19–30. 2013. View Article : Google Scholar : PubMed/NCBI
24	Gerges FJ, Kanazi GE and Jabbour-Khoury SI: Anesthesia for laparoscopy: A review. J Clin Anesth. 18:67–78. 2006. View Article : Google Scholar : PubMed/NCBI
25	Mangram AJ, Horan TC, Pearson ML, Silver LC and Jarvis WR: Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 27:96–132. 1999.