No adverse long-term oncologic outcomes of laparoscopic resection were observed in this study. Although inherent limitations exist in this nonrandomized study, laparoscopic multivisceral resection seems to be a feasible and effective treatment option for colorectal cancer for carefully selected patients. Patients with colon cancer should be much more carefully selected for laparoscopic multivisceral resection than patients with rectal cancer because anatomic uncertainty can make oncologic en bloc resection incomplete.

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The aim of our study is to assess short-term and long-term outcomes after laparoscopic radical rectal cancer resection in octogenarians compared with those in patients 60 years old or younger. Methods: Using a prospectively collected database of laparoscopic colorectal resections by a single surgeon from March 2001 to December 2012, we retrospectively reviewed 49 octogenarian rectal cancer patients and 63 younger counterparts. Results: The American Society of Anesthesiologists (ASA) score (P< 0.001), history of previous abdominal surgery (P= 0.019), preoperative prevalence of other malignancy (P= 0.001), perioperative transfusion (P= 0.032), and cardiorespiratory comorbidities (P< 0.001) were significantly higher in octogenarians. No difference existed between two groups in terms of preoperative chemoradiation rate, surgical procedures, distal and radial resection margin, harvested lymph node number, and tumor node metastasis (TNM) staging. The rates of at least one complication (P= 0.019), postoperative ileus (P= 0.006) and cardiopulmonary complication (P= 0.021) were higher in octogenarians, but rates of leakage and reoperation were not high. During median follow-up of 53 months, one pelvic recurrence developed in octogenarians. The overall 5-year survival rate was 63.9% in octogenarians and 93.7% in younger patients (P< 0.001). Two-year disease free survival rate for pathologic stage III in octogenarians was 51.0%, much lower (P= 0.008), but not so for stage 0-II than in younger patients. Conclusion:Octogenarian rectal cancer patients have more preoperative comorbidities and the benefit of laparoscopic rectal resection was still limited for reducing cardiopulmonary complication. More sophisticated preoperative assessment should be needed to find out very frail patients and less invasive alternative treatment should be taken into consideration for them.