Outcomes of Laparoscopic Versus Open Surgery in Elderly Patients with Rectal Cancer

Abstract

Background: Laparoscopic colorectal resection has been gaining popularity over the past two decades-and the number of elderly patients with colorectal cancer treated with a surgical modality has gradually increased. However, studies about laparoscopic rectal surgery in elderly patients with long-term oncologic outcomes are limited. In this study, we evaluated the safety and effectiveness of laparoscopic resection in patients with rectal cancer aged ≥80 y. Methods: From 2007-2015, a total of 84 consecutive patients with rectal cancer from a single institution were included, 45 patients undergoing laparoscopic rectal resection were compared with 39 patients undergoing open rectal resection. Results: The two groups were well balanced in terms of age, gender, body mass index, American society of anesthesiologists scores, previous abdominal surgery, neoadjuvant therapy, tumor stage, distance of tumor from the anal verge, and comorbidities. One (2.2%) patient in the laparoscopic group required conversion to open surgery. Laparoscopic surgery was associated with significantly longer operating time (160.1±28.2 versus 148.2±41.3 min; P=0.031), less intraoperative blood loss (80.5±20.9 versus 160.3±42.4 mL; P=0.002), less need of blood transfusion (6.7% versus 20.5%; P=0.003), a shorter time to diet recovery (2.5±1.5 versus 4.9±1.1; P=0.015) and postoperative hospital stay (7.5±4.5 versus 10.8±4.2; P=0.035), lower overall postoperative complication rate (8.9% versus 20.5%; P=0.017), and wound-related complication rate (4.4% versus 10.2%; P=0.013) when compared with open surgery. Specimen length, no. of retrieced lymph nodes, positive distal and circumferential margin rate, mortality rate, and reoperation rate were not significantly different between two groups. The disease-free and overall 5-year survival rates were similar between two groups.Conclusions: Laparoscopic rectal surgery is safe and feasible in patients aged≥80 y and is associated with similar long-term oncologic outcomes when compared with open surgery.

Continuing Care Bundle in Elderly Patients with Rectal Cancer after Radical Resection with Permanent Stoma

“…Similar to other malignancies, the incidence rate of rectal cancer increased with the onset of old age, and it was reported that approximately 65% patients with rectal cancer aged 65 years and older had the disease [ 3 ]. Besides, the number of elderly patients with rectal cancer who underwent surgical treatment has gradually increased along with the aging society [ 4 ]. However, 1.6%∼20.5% of patients developed anastomotic leakage following rectal cancer surgery [ 5 ], and a temporary or permanent stoma, in some cases, was necessary for treating rectal cancer in elderly patients to decrease the clinical level of anastomotic leakage as reported by several studies [ 6 , 7 ].…”

Features and outcomes of rectal cancer patients treated in a hospital in Bogotá, Colombia: a retrospective cohort study

“…The most frequent procedure in our department was a laparoscopic anterior resection of the rectum, routinely with a protective ileostomy, with a low percentage of conversion to open surgery generally associated with more advanced tumor stages, according to Pedziwiatr and cols, in a systematic review with 2018 patients with laparoscopic management and 1526 with an open approach, do not identify differences in positive circumferential margins (RR 1.16, 95% CI 0.89–1.50) or complete mesorectal excision (-0.01, 95% CI − 0.89 to 0.87), considering the two approaches equivalent in terms of oncological results 14 – 16 .…”

Open Versus Laparoscopic Surgery for Rectal Cancer in Elderly Patients With Comorbidities

“…Qi Zhang et al noted that, from the oncological point of view, laparoscopic surgery provides an efficient total mesorectal excision and lymph node harvesting, facts that assure a good 5-year disease-free survival rate 14 . In our study, all the patients underwent total mesorectal excision and most of them D2 lymphadenectomy and there were no major differences regarding long-term survival between the two analyzed groups.…”