Laparoscopic Surgery for Colorectal Cancer in Super-Elderly Patients: A Single-Center Analysis

Hashida, Hiroki; Mizuno, Ryosuke; Iwaki, Kentaro; Kanbe, Hiroyuki; Sumi, Tokihiko; Kawarabayashi, Takuma; Kondo, Masato; Kobayashi, Hiroyuki; Kaihara, Satoshi

doi:10.1097/sle.0000000000000876

“…Laparoscopic technology has been widely used in the treatment of colorectal cancer [ 11 – 13 ]. Compared with traditional open surgery, laparoscopic surgery has minimally invasive advantages such as less trauma, less postoperative pain, and faster recovery.…”

Section: Discussionmentioning

confidence: 99%

Application Effect of Robot-Assisted Laparoscopy in Hepatectomy for Colorectal Cancer Patients with Liver Metastases

Li

¹

,

Fu²

2022

Computational and Mathematical Methods in Medicine

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Objective. Application effect of Leonardo’s robot-assisted laparoscopy in hepatectomy for colorectal cancer patients with liver metastases. Methods. A total of 122 patients with sCRLM treated in our hospital from May 2015 to June 2018 were selected and divided into observation group ( n = 61 ) and control group ( n = 61 ) according to random number table method. The observation group was treated with robot-assisted laparoscopic hepatectomy, while the control group was treated with conventional laparoscopic hepatectomy. The perioperative time, intraoperative blood transfusion, intraoperative blood loss, average intraoperative blood transfusion, and hepatic portal occlusion time of the two groups were observed. Serum cortisol (Cor), norepinephrine (NE), and glucose (Glu) levels were detected before and after surgery in the two groups. The oxygen consumption and carbon dioxide output of patients were measured 1 day before surgery and 1~3 days after surgery, and the resting energy expenditure (REE) value was calculated. The levels of CD3+, CD4+, and CD8+ were determined by flow cytometry. The incidence of complications was compared between the two groups. Patients were followed up for 3 years after discharge, and Kaplan-Meier method was used to analyze the survival of the two groups. Results. The operation time, intraoperative blood transfusion, intraoperative blood loss, and average intraoperative blood transfusion in the observation group were all less than those in the control group, and the differences were statistically significant ( P < 0.05 ). Three days after operation, the levels of serum Cor, NE, and Glu were increased in both groups, and the observation group was lower than the control group; the difference was statistically significant ( P < 0.05 ). The REE level of observation group was lower than that of control group after 1 day, 2 days, and 3 days after surgery, and the difference was statistically significant ( P < 0.05 ). Three days after operation, the levels of serum CD3+ and CD4+ were decreased in both groups, and the observation group was higher than the control group; the difference was statistically significant ( P < 0.05 ). The incidence of complications in the observation group (3.28%) was lower than that in the control group (13.11%); the difference was statistically significant ( P < 0.05 ).There was no significant difference in survival rate between the two groups after 1, 2, and 3 years of follow-up ( P > 0.05 ). Conclusion. The application of robot-assisted laparoscopy in patients with sCRLM can effectively improve the perioperative situation of patients, reduce stress, energy metabolism, and immune damage, and reduce the incidence of complications.

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“…This conclusion is supported by research from Vallribera Valls et al [ 14 ] who demonstrated that laparoscopic approaches in those over 85 are not associated with an increase in morbidity or length of stay. This is also mirrored by more recent studies of Ueda et al [ 15 ] and Hashida et al [ 16 ], both of whom have demonstrated laparoscopic surgery in the elderly population to be feasible, safe and have equitable outcomes to those in younger age brackets.…”

Section: Discussionmentioning

confidence: 66%

Should we resect colorectal cancer in patients over the age of 85?

Flynn

¹

,

Mao

²

,

Yerkovich

³

et al. 2021

WJGO

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BACKGROUND The prevalence of colorectal cancer in the elderly is rising, with increasing numbers of older patients undergoing surgery. However, there is a paucity of information on the surgical outcomes and operative techniques used in this population. AIM To evaluate the post-operative outcomes for patients ≥ 85 years old following colorectal cancer resection as well as evaluating the outcomes of laparoscopic resection of colorectal cancer in patients over 85. METHODS Patients who underwent colorectal cancer resection at our institution between January 2010 and December 2018 were included. The study was divided into two parts. For part one, patients were divided into two groups based on age: Those age ≥ 85 years old ( n = 48) and those aged 75-84 years old ( n = 136). Short term surgical outcomes and clinicopathological features were compared using appropriate parametric and non-parametric testing. For part two, patient’s over 85 years old were divided into two groups based upon operative technique: Laparoscopic ( n = 37) vs open ( n = 11) colorectal resection. Short-term post-operative outcomes of each approach were assessed. RESULTS The median length of stay between patients over 85 and those aged 75-85 was eight days, with no statistically significant difference between the groups ( P = 0.29). No significant difference was identified between the older and younger groups with regards to severity of complications ( P = 0.93), American Society of Anaesthesiologists grading ( P = 0.43) or 30-d mortality (2% vs 2%, P = 0.96). Patients over 85 who underwent laparoscopic colorectal resection were compared to those who underwent an open resection. The median length of stay between the groups was similar (8 vs 9 d respectively) with no significant difference in length of stay ( P = 0.18). There was no significant difference in 30-d mortality rates (0% vs 9%, P = 0.063) or severity of complication grades ( P = 0.46) between the laparoscopic and open surgical groups. CONCLUSION No significant short term surgical differences were identified in patients ≥ 85 years old when compared to those 75-85 years old. There is no difference in short term surgical outcomes between laparoscopic or open colorectal resections in patients over 85.

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“…The super elderly group constitutes a special population, which is constantly increasing (1,5)(1,5)(1,5)(1,3), and deserves specialized studies due to their characteristics [ 18 , 19 ]. Benign biliary pathology is not the only exception and complications associated to cholelithiasis and age should be taken into account [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute calculous cholecystitis in patients over 90 years of age

Van-Londoño

¹

2023

Langenbecks Arch Surg

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Background Laparoscopic cholecystectomy (LC) is the standard of care for acute calculous cholecystitis; however, in patients at high risk for surgery, particularly in the elderly, insertion of a percutaneous catheter drainage (PCD) at gallbladder is recommended. Current evidence suggests that PCD may have less favorable outcomes than LC, but also that LC-associated complications increase in direct relation to patient age. There is no recommendation supported by robust evidence to decide between one or the other procedure in super elderly patients. Methods A retrospective observational cohort study was designed to analyze the surgical outcomes of super elderly patients with cholecystitis who underwent LC versus PCD for treatment. The surgical outcomes of a subgroup of high-risk patients were also analyzed. Results A total of 96 patients who met the inclusion criteria between 2014 and 2021 were included. The median age of patients were 92 years (IQR: 4.00) with a female predominance (58.33%). The overall morbidity rate in the series was 36.45% and mortality rate was 7.29%. There was no statistically significant difference when compared to the associated morbidity and mortality among patients who underwent LC versus those who underwent PCD, neither in the analysis of the complete series or in the subgroup of high-risk patients. Conclusions The morbidity and mortality associated with the two most frequently recommended therapeutic options for operating super elderly patients with acute cholecystitis are high. We found no evidence of superiority in outcomes for either of the two procedures in this age group.

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Laparoscopic Surgery for Colorectal Cancer in Super-Elderly Patients: A Single-Center Analysis

Cited by 7 publications

References 18 publications

Application Effect of Robot-Assisted Laparoscopy in Hepatectomy for Colorectal Cancer Patients with Liver Metastases

Application Effect of Robot-Assisted Laparoscopy in Hepatectomy for Colorectal Cancer Patients with Liver Metastases

Should we resect colorectal cancer in patients over the age of 85?

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute calculous cholecystitis in patients over 90 years of age

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