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News

Laparoscopic vs open colorectal resection for colorectal cancer in the very elderly patient

A review in September's issue of the International Journal of Colorectal Disease compares laparoscopic with open colorectal resection for colorectal cancer surgery in the very elderly patient.

News image

Colorectal cancer is the second most common cause of death from neoplastic disease in men and third in women of all ages.

Globally, life expectancy is increasing, and consequently, an increasing number of operations are being performed on more elderly patients with the trend set to continue.

Elderly patients are more likely to have cardiovascular and pulmonary comorbidities that are associated with increased peri-operative risk.

They further tend to present with more locally advanced disease, more likely to obstruct or have disseminated disease.

Dr Laurence Devoto and colleagues from the United Kingdom investigated the feasibility of laparoscopic colorectal resection in very elderly patients, and whether there are benefits over open surgery for colorectal cancer.

Overall mortality for elective laparoscopic resection was 3%
International Journal of Colorectal Disease

The researchers performed a systematic literature search on Medline, Pubmed, Embase and Google Scholar.

All comparative studies evaluating patients undergoing laparoscopic versus open surgery for colorectal cancer in the patients population over 85 were included.

The team's primary outcomes were 30-day mortality and 30-day overall morbidity.

Secondary outcomes were operating time, time to oral diet, number of retrieved lymph nodes, blood loss and 5-year survival.

The researchers identified 1507 citations.

The team retrieved 69 articles for full text analysis, and only 6 retrospective studies met the inclusion criteria.

Overall mortality for elective laparoscopic resection was 3% and morbidity 23%.

No single study showed a significant difference between laparoscopic and open surgery for morbidity or mortality, but pooled data analysis demonstrated reduced morbidity in the laparoscopic group.

The team noted that patients undergoing laparoscopic surgery are more likely to have a shorter hospital stay and a shorter time to oral diet.

Dr Devoto's team concluded, "Elective laparoscopic resection for colorectal cancer in the over 85 age group is feasible and safe, and offers similar advantages over open surgery to those demonstrated in patients of younger ages."

Int J Col Dis 2017: 32(9): 1237–1242
06 September 2017

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