Short-term outcomes between laparoscopy-assisted and open colorectomy for colorectal cancer in elderly patients: A case-matched control study

Abstract

Abstract. With the increase in life expectancy, surgical intervention for colorectal cancer (CRC) is more frequently performed in elderly patients. This retrospective study was designed to compare short-term outcomes between laparoscopy-assisted colorectomy (LC) and open colorectomy (OC) in elderly patients with CRC. A total of 89 CRC patients aged ≥75 years undergoing LC were matched with 89 counterparts undergoing OC. The matching criteria included general information and preoperative status. The operative data and short-term postoperative outcomes were compared. Following analysis, patients in the LC and OC groups were comparable for the matching criteria. Compared with the OC group, the operative time was longer (P=0.046), but the estimated blood loss (P<0.001) and intraoperative transfusion (P=0.042) were less in the LC group. As regards short-term postoperative outcomes, the duration of postoperative hospital stay was shorter (P=0.001) and the incidence of wound complications was lower (P=0.044) with LC. The overall complication, other complications, reoperation and mortality rates were comparable between the two groups. In conclusion, considering the operative variables and short-term outcomes, LC is a safe procedure and appears to be superior to OC for elderly patients with CRC. IntroductionDue to the significant advances in life quality and health care, life expectancy continues to increase worldwide, with a consequent increase in the elderly population. The incidence of colorectal diseases necessitating surgical intervention, particularly colorectal cancer (CRC), usually increases with advancing age. In fact, approximately one half of patients with CRC are aged >70 years and CRC is the second leading cause of cancer-related mortality in this age group (1,2). Aging per se, regardless of other factors, is not a prognostic factor in gastrointestinal surgery (3). However, advanced age is usually accompanied by underlying comorbidities, such as cardiovascular and pulmonary diseases, which may significantly affect the outcomes of surgical treatment for CRC. Thus, surgery for elderly CRC patients is a major medical care issue.Surgeons usually select colorectomy for CRC treatment in resectable cases, which may be performed as open colorectomy (OC) or laparoscopy-assisted colorectomy (LC). The laparoscopic procedure, compared with laparotomy, is considered to be a safe and feasible procedure, associated with a milder immunological and inflammatory response (4). Furthermore, LC is reportedly associated with decreased morbidity and mortality, faster recovery and shorter hospital stay (5,6). However, LC usually requires longer operative time and results in specific physiological changes affecting the cardiovascular and pulmonary systems (7). Due to these concerns and underlying comorbidities in elderly patients, surgeons face a dilemma when considering LC for CRC.The availability of recent reports comparing LC and OC for elderly patients is limited (8-12), with data on CRC being even more scarse (12). To the best...

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