Safety and Efficacy of Laparoscopic Surgery versus Open Surgery in Elderly Patients with Colon Cancer: A Propensity Score Matching Cohort Study

Abstract

Introduction: The safety of laparoscopic surgery (LS) and its effect on survival have not been sufficiently assessed in elderly colon cancer patients. Methods: Clinicopathologic data of patients aged ≥ 75 years who underwent colectomies for primary colon cancer, between January 2018 and June 2021, were reviewed. Patients were divided into LS and open surgery (OS) groups according to the intention-to-treat principle, and were compared using propensity score matching. The primary outcomes were differences in surgical safety and 3-year survival rates. Results: There were 98 patients with a median age of 82 years and 85 patients with a median age of 80 years, assigned to the OS and LS groups, respectively. Propensity score matching revealed that LS did not prolong the operation time (190 versus 180 min, P = 0.209), was linked to less intraoperative blood loss (50 versus 100 mL, P = 0.039) and shorter postoperative hospital stays (8 versus 10 days, P = 0.005), compared to OS. In addition, LS was not accompanied by more stress responses when the variations exhibited in laboratory tests and the Barthel index pre- and post- surgery were considered. There were no significant differences in the adjusted 3-year overall survival (86.0% versus 81.2%, P = 0.795) and disease-free survival (86.6% versus 87.9%, P = 0.356) rates between the groups. Conclusion: LS enhanced post-operative recovery without increasing surgical risks, compared to OS, in colon cancer patients aged ≥ 75 years. Furthermore, no significant differences in the 3-year adjusted survival rates were observed between the groups.

Comparison of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic surgery and the identification of predictive factors influencing the delayed recovery of neurocognitive function

“…Laparoscopic surgery, known for its advantages of minimal trauma, reduced bleeding, and faster postoperative recovery compared to open surgery (1)(2)(3). The concept of anesthesia and perioperative Enhanced Recovery After Surgery has brought forth new and significantly higher demands on anesthesia during laparoscopic surgery (4,5). It not only requires ensuring safe anesthesia but also focuses on achieving faster recovery.…”