The number and proportion of patients aged 80 years or more are increasing. These patients often require surgical care, and suffer subsequent high rates of morbidity and mortality. However, the surgical outcomes of laparoscopic colorectal resection in octogenarians are not well documented.
The study, conducted by members of The University of Toronto Center for Minimally Invasive Surgery in Ontario, Canada, identified octogenarians from a large prospective database comprising 507 consecutive laparoscopic colorectal resections.
These resections were all carried out between 1991 and 1997 within a university setting.
The study examined both preoperative comorbidity and surgical outcomes.
|Laparoscopic colorectal resection:|
- technically feasible.
- safe in elderly patients.
A total of 62 patients (30 men and 32 women) aged 80 years or more were identified from the original search database (mean age 85 years, mean weight 63 kg).
Of these, 7 (11%) were converted to an open procedure, while 4 (6%) experienced 4 different intra-operative complications, necessitating 2 conversions.
The complications were 1 colon perforation, 1 small bowel perforation, 1 burned gall-bladder serosa, and 1 missed lesion.
The study found 19 patients (31%) had experienced post-operative complications. These comprised 6 ileus (10%), 5 wound infections (8%), 5 cardiac problems (8%), 2 urinary infections (3%), 2 hemorrhages (3%), 1 abscess (2%), 1 pneumonia (2%), and 2 others (3%).
There was no association between intra-operative complications and post-operative morbidity. Three patients (5%) died within 30 days of surgery.
When the procedure was completed laparoscopically, the overall median post-operative hospital stay was 10 days. Occurrence of a post-operative complication increased the median length of stay to 15 days.
P.A. Seshadri concluded on behalf of his fellow authors, "These results are superior to published historical controls involving open colorectal resection in octogenarians. Overall mortality, and lung and urinary tract complications, were all decreased, and there were no re-operations for small bowel obstruction."
He added, "Laparoscopic colorectal resection is technically feasible and can be done safely in elderly patients. Results require randomization against those for open surgery to elucidate the real advantages of this technique."