Efficacy of hand-assisted laparoscopic surgery (HALS) in older adult patients (≥80 years) with primary colorectal cancer

Abstract

Background: From 2004 to 2014, 821 colorectal cancer primary resections were conducted at our institution. Of these, 102 patients (12.4%) were older adults over 80 years old. underwent either the conventional laparotomy group (72 patients) or the hand-assisted laparoscopic surgery (HALS) group (30 patients).Methods: Data were extracted for 102 patients over 80 years old who underwent primary resection for colorectal cancer and were divided into two groups: conventional laparotomy (CL) (n=72) and hand-assisted laparoscopy (n=30). Pre-operative characteristics and outcomes were compared.Results: Baseline characteristics were similar between groups, except for age: CL group median 83.5 years old (range, 80-92 years old) and hand-assisted laparoscopy (HALS) group median 81.5 years old (range, 80-88 years old) (P=0.027). Pre-operative cardiac and lung function risk, performance status, and pathological classification stage (pStage) were almost similar between groups (P=0.668, P=0.176, P>0.999, P=0.217). No significant differences were found for operation time. The HALS group resulted in less blood loss (median 204 mL in the CL group and median 68 mL in the HALS group, P=0.003), shorter postoperative hospital stay (median was 18 days in the CL group and median was 12 days in the HALS group, P<0.001), and fewer postoperative wound infections (18 cases in the CL group and 2 cases in the HALS group, P=0.034). Five-year relapse-free survival (5Y-RFS) was 48.1% in the CL group and 73.3% in the HALS group (P=0.028). Five-year overall survival (5Y-OS) was 48.2% in the CL group and 73.3% in the HALS group (P=0.027).Conclusions: Approximately 70% of surgical treatment for patients over 80 years old with colorectal carcinoma were performed by CL. However, HALS had significant advantages including less blood loss, fewer wound infections, and shorter hospital stays. Therefore, HALS could proactively be considered to older adult patients with colorectal cancer.

The safety and feasibility of Hand-Assisted Laparoscopic technology in splenectomy

“…[18] In fact, hand-assisted laparoscopic technology has been applied in many disciplines, even radical surgery for malignant tumors. [10,19,20] But HALS has not been widely recognized and accepted. Recent years, with the rapid development of interventional technology, Hypersplenism due to liver cirrhosis and Portal Hypertension maybe alleviated by transjugular intrahepatic portosystemic shunt (TIPS) or splenic artery embolization [10,19,20].…”

“…[10,19,20] But HALS has not been widely recognized and accepted. Recent years, with the rapid development of interventional technology, Hypersplenism due to liver cirrhosis and Portal Hypertension maybe alleviated by transjugular intrahepatic portosystemic shunt (TIPS) or splenic artery embolization [10,19,20]. From my study, pure splenectomy due to Portal hypertension is only three patients.…”