Is laparoscopic Colorectal Surgery Beneficial for Elderly Patients? A Systematic Review and Meta-Analysis

Seishima, Ryo; Okabayashi, Koji; Hasegawa, Hirotoshi; Tsuruta, Masashi; Shigeta, Kohei; Matsui, Shimpei; Yamada, Tōru; Kitagawa, Yuko

doi:10.1007/s11605-015-2748-9

Cited by 55 publications

(29 citation statements)

References 56 publications

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“…Because of the aging of the population, combined with the fact that colorectal surgery is the most commonly performed major surgery on elderly patients [ 2 3 ], colorectal surgeons should expect to operate more frequently on elderly patients [ 4 ]. Elderly patients are often categorized as high-risk patients due to their having significant comorbidity with increasing postoperative morbidity and mortality [ 5 ]. The 30-day morbidity and mortality rates are 20% and 6%, respectively, for patients aged ≥70 years of age [ 4 5 ].…”

Section: Introductionmentioning

confidence: 99%

Outcome of Colorectal Surgery in Elderly Populations

et al. 2016

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PurposeThe aim of this study is to investigate the impact of age on short-term outcomes after colorectal surgery in terms of the 30-day postoperative morbidity and mortality rates.MethodsThe subjects for the study were patients who had undergone colorectal surgery. Patients were divided into 2 groups according to age; groups A and B patients were ≥80 and <80 years old of age, respectively. Both groups were manually matched for body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index and procedure performed.ResultsA total of 200 patients, 91 men (45.5%) and 109 women (54.5%), were included in this retrospective study. These patients were equally divided into 2 groups. The mean ages were 85 years in group A (range, 80 to 104 years) and 55.3 years in group B (range, 13 to 79 years). The overall 30-day postoperative mortality rate was 1% of total 200 patients; both of these 2 patients were in group A. However, this observation had no statistical significance. No intraoperative complications were encountered in either group. The overall 30-day postoperative morbidity rate was 27% (54 of 200) for both groups. The 30-day postoperative morbidity rates in groups A and B were 28% (28 of 100) and 26% (26 of 100), respectively. However, these differences between the groups had no statistical significance importance.ConclusionAge alone should not be considered to be more of a contraindication or a worse predictor than other factors for the outcome after colorectal surgery on elderly patients.

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Section: Introductionmentioning

confidence: 99%

Outcome of Colorectal Surgery in Elderly Populations

et al. 2016

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“…Li et al[26], in a systematic review and meta-analysis of patients older than 80 years undergoing colonic resection, demonstrated the benefits of laparoscopic surgery such as decreased LOS and morbidity. Similarly, Seishima et al[27] reported lowered risk of morbidity and mortality in the geriatric patient undergoing laparoscopic colorectal surgery. Based on these data, the author recommended an “Aggressive application of laparoscopic surgery in the elderly population”.…”

Section: Discussionmentioning

confidence: 97%

Impact of frailty on approach to colonic resection: Laparoscopy vs open surgery

Mosquera¹,

Spaniolas²,

Fitzgerald³

2016

WJG

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AIMTo understand the influence of frailty on postoperative outcomes for laparoscopic and open colectomy.METHODSData were obtained from the National Surgical Quality Improvement Program (2005-2012) for patients undergoing colon resection [open colectomy (OC) and laparoscopic colectomy (LC)]. Patients were classified as non-frail (0 points), low frailty (1 point), moderate frailty (2 points), and severe frailty (≥ 3) using the Modified Frailty Index. 30-d mortality and complications were used as the primary end point and analyzed for the overall population. Complications were grouped into major and minor. Subset analysis was performed for patients undergoing colectomy (total colectomy, partial colectomy and sigmoid colectomy) and separately for patients undergoing rectal surgery (abdominoperineal resection, low anterior resection, and proctocolectomy). We analyzed the data using SAS Platform JMP Pro version 10.0.0 (SAS Institute Inc., Cary, NC, United States).RESULTSA total of 94811 patients were identified; the majority underwent OC (58.7%), were white (76.9%), and non-frail (44.8%). The median age was 61.3 years. Prolonged length of stay (LOS) occurred in 4.7%, and 30-d mortality was 2.28%. Patients undergoing OC were older (61.89 ± 15.31 vs 60.55 ± 14.93) and had a higher ASA score (48.3% ASA3 vs 57.7% ASA2 in the LC group) (P < 0.0001). Most patients were non-frail (42.5% OC vs 48% LC, P < 0.0001). Complications, prolonged LOS, and mortality were significantly more common in patients undergoing OC (P < 0.0001). OC had a higher risk of death and complications compared to LC for all frailty scores (non-frail: OR = 4.7, and OR = 4.67; mildly frail: OR = 2.51, and OR = 2.47; moderately frail: OR = 2.94, and OR = 2.02, severely frail: OR = 2.37, and OR = 2.34, P < 0.05) and an increase in absolute mortality with increasing frailty (non-frail 0.68% OC, mildly frail 1.39%, moderately frail 3.44%, and severely frail 5.83%, P < 0.0001).CONCLUSIONLC is associated with improved outcomes. Although the odds of mortality are higher in non-frail, there is a progressive increase in mortality with increasing frailty.

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“…Conversely, all the participating hospitals in our study had high proportion (56%) of operations done by laparoscopy, and enhanced recovery after surgery (ERAS) program was gradually adopted to clinical work during the study period. A recent meta-analysis demonstrated that laparoscopic colorectal surgery has positive impact in terms of significant decrease in postoperative morbidity and mortality among the aged compared with open colorectal surgery [34]. ERAS is a multimodal approach that aims to optimize perioperative management [35].…”

Section: Discussionmentioning

confidence: 99%

Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

Niemeläinen

Huhtala

Ehrlich

et al. 2019

Int J Colorectal Dis

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Purpose Patients aged > 80 years represent an increasing proportion of colon cancer diagnoses. Selecting patients for elective surgery is challenging because of possibly compromised health status and functional decline. The aim of this retrospective, population-based study was to identify risk factors and health measures that predict short-term mortality after elective colon cancer surgery in the aged. Methods All patients > 80 years operated electively for stages I-III colon cancer from 2005 to 2016 in four Finnish hospitals were included. The prospectively collected data included comorbidities, functional status, postoperative surgical and medical outcomes as well as mortality data. Results A total of 386 patients (mean 84.0 years, range 80-96, 56% female) were included. Male gender (46% vs 35%, p = 0.03), higher BMI (51% vs 37%, p = 0.02), diabetes mellitus (51% vs 37%, p = 0.02), coronary artery disease (52% vs 36%, p = 0.003) and rheumatic diseases (67% vs 39%, p = 0.03) were related to higher risk of complications. The severe complications were more common in patients with increased preoperative hospitalizations (31% vs 15%, p = 0.05) and who lived in nursing homes (30% vs 17%, p = 0.05). The 30-day and 1-year mortality rates were 6.0% and 15% for all the patients compared with 30% and 45% in patients with severe postoperative complications (p < 0.001). Severe postoperative complications were the only significant patient-related variable affecting 1-year mortality (OR 9.60, 95% CI 2.33-39.55, p = 0.002). Conclusions The ability to identify preoperatively patients at high risk of decreased survival and thus prevent severe postoperative complications could improve overall outcome of aged colon cancer patients.

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Is laparoscopic Colorectal Surgery Beneficial for Elderly Patients? A Systematic Review and Meta-Analysis

Abstract: Laparoscopic colorectal surgery in the elderly population has significant advantages in terms of short-term outcomes. Aggressive application of laparoscopic colorectal surgery should be considered for the elderly population.

Cited by 55 publications

References 56 publications

Outcome of Colorectal Surgery in Elderly Populations

Outcome of Colorectal Surgery in Elderly Populations

Impact of frailty on approach to colonic resection: Laparoscopy vs open surgery

Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

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