Single‐port laparoscopic colectomy in elderly patients with colon cancer: A propensity score‐matched comparison with younger patients

Hirano, Yasumitsu; Hiranuma, Chikashi; Hattori, Masao; Douden, Kenji; Yamaguchi, Shigeki

doi:10.1111/ases.12719

Asian J Endoscop Surgery

2019

DOI: 10.1111/ases.12719

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Single‐port laparoscopic colectomy in elderly patients with colon cancer: A propensity score‐matched comparison with younger patients

Yasumitsu Hirano

Chikashi Hiranuma

Masao Hattori

et al.

Abstract: Introduction This study aims to evaluate the safety and feasibility of single‐port laparoscopic colectomy (SPLC) in elderly patients with colon cancer. Methods During the study period, 344 patients underwent SPLC in our hospital. Among them, 87 patients were aged 80 years and older, and 257 patients were younger than 80 years. After 1:1 propensity‐score matching, 87 elderly patients were compared with 87 young patients. Results Short‐term clinical outcomes after SPLC were equivalent between the two groups, alt… Show more

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“…Some even report that the prognosis of MUC is better (8). This variation in opinion is most likely due to the inconsistent background characteristics of patients with an MUC or ADC history.Recently, propensity score matching (PSM) has been widely used in clinical studies to minimize the potential for confounding between study groups (9,10…”

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confidence: 99%

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Mucinous Adenocarcinoma as a High-risk Factor in Stage II Colorectal Cancer: A Propensity Score-matched Study from Japan

et al. 2020

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Background/Aim: The purpose of this study was to investigate the clinical, pathological, and prognostic differences between adenocarcinoma (ADC) and mucinous adenocarcinoma (MUC) in colorectal cancer (CRC). Patients and Methods: This was a retrospective study of a Japanese high-volume cancer Center over a 10-year period. From April 2007 to December 2016, a total of 3,296 patients with primary CRC were included in the study. The clinical characteristics of MUC and ADC were compared. Then, propensity score matching was performed according to a 1:2 ratio. Multivariate analysis was used for independent risk factors related to prognosis. The overall survival (OS) and disease-free survival (DFS) of 126 cases of MUC and 256 cases of ADC were studied, as well as the survival rate of each stage. Results: MUC accounts for 3.82% of the total CRC. Compared to ADC, MUC is more common in female patients (47.62% vs. 38.77%; p=0.045), with higher carcinoembryonic antigen levels (56.35% vs. 34.95%; p<0.001), more ulcerative and infiltrative types (82.54% vs. 72.93%; p=0.016), higher incidence of perineural infiltration (51.59% vs. 41.04%; p=0.018), deeper infiltration (T3-T4: 90.48% vs. 65.84%; p<0.001), and more advanced cancer (stage III-IV: 59.52% vs. 44.79%; p=0.001). MUC is also more likely to recur (24.6% vs. 14.32%; p=0.001). Regarding the long-term survival rate, the OS (p<0.001) and DFS (p=0.05) is consequently worse. After propensity score matching, multivariate analysis showed that MUC was a common independent risk factor for DFS [odds ratio (OR)=4.277; 95% confidence interval (CI), 0.327-0.97; p=0.039], and also for OS (OR= 6.836; 95% CI, p=0.009). In MUC, OS and DFS were still relatively worse (OS: p=0.017; DFS: p=0.038). However, only significant statistical differences were shown in stage II (OS: p=0.003; DFS: p=0.007). No significant differences were noted in the stages I, III, or IV. Conclusion: MUC is a high-risk factor for stage II CRC. Adjuvant chemotherapy should be routinely recommended for patients with MUC stage II, and special attention should be paid during their follow-up.According to European and American guidelines, patients with a high risk of recurrence after radical surgery for stage II colorectal cancer (CRC) should receive adjuvant chemotherapy (1, 2). However, the definition of "high risk" varies. Mucinous adenocarcinoma (MUC) is defined as a high-risk factor in United States guidelines, but not in European guidelines. In Japan, clinical trials of conventional postoperative adjuvant chemotherapy for stage II CRC have not been found to be successful (3). In 2019, there are few Japanese guidelines for the treatment of stage II rectal cancer using adjuvant chemotherapy (4). There are also different opinions on whether or not adjuvant chemotherapy is required for patients with postoperative stage II MUC.MUC is a rare tumor classification of CRC. This type of tumor contains neoplastic cells that produce a large amount of extracellular mucin. Histological markers require more than 50% of the tumor...

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confidence: 99%

“…Recently, propensity score matching (PSM) has been widely used in clinical studies to minimize the potential for confounding between study groups (9,10…”

mentioning

confidence: 99%

Mucinous Adenocarcinoma as a High-risk Factor in Stage II Colorectal Cancer: A Propensity Score-matched Study from Japan

et al. 2020

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Biochemical outcomes and toxicities in young men with prostate cancer after permanent iodine-125 seed implantation: Prospective cohort study in 6662 patients

et al. 2023

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Interval laparoscopic appendectomy after antibiotic therapy for appendiceal abscess in elderly patients

Mima

Miyanari

Itoyama

et al. 2019

Asian J Endoscop Surgery

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IntroductionThe aim of this study was to evaluate the safety and efficacy of interval laparoscopic appendectomy after antibiotic therapy in elderly patients with appendiceal abscess.MethodsWe retrospectively analyzed data for 50 patients with appendiceal abscess aged ≥18 years who had initially planned to undergo interval laparoscopic appendectomy after antibiotic therapy and 50 patients with appendicitis aged ≥70 years who had undergone early laparoscopic appendectomy. All patients were treated at the National Hospital Organization Kumamoto Medical Center between 2012 and 2018. We compared perioperative outcomes after interval appendectomy between patients aged <70 years and ≥70 years.ResultsClinical progression of appendicitis during antibiotic therapy developed in one patient (2.0%), and recurrent appendicitis after antibiotic therapy for appendiceal abscess occurred in two patients (4.0%). Pathological findings confirmed appendiceal neoplasms in four patients (8.0%). Postoperative infectious complications occurred in 1 of 47 patients (2.1%) who had undergone successful interval laparoscopic appendectomy, and the median length of postoperative hospital stay was 4 days (interquartile range, 3‐5 days). There were no significant differences in outcomes after interval appendectomy between patients aged <70 years and ≥70 years. In the secondary analysis, the median length of postoperative hospital stay after interval laparoscopic appendectomy for appendiceal abscess (4 days) was significantly shorter than that after early laparoscopic appendectomy for uncomplicated appendicitis (7 days; P < .001).ConclusionsInterval laparoscopic appendectomy for appendiceal abscess may be safe and effective in elderly patients without severe comorbidities. Interval appendectomy may be necessary for determining the underlying cause of appendiceal abscess in adults.

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Single‐port laparoscopic colectomy in elderly patients with colon cancer: A propensity score‐matched comparison with younger patients

Cited by 3 publications

References 9 publications

Mucinous Adenocarcinoma as a High-risk Factor in Stage II Colorectal Cancer: A Propensity Score-matched Study from Japan

Mucinous Adenocarcinoma as a High-risk Factor in Stage II Colorectal Cancer: A Propensity Score-matched Study from Japan

Biochemical outcomes and toxicities in young men with prostate cancer after permanent iodine-125 seed implantation: Prospective cohort study in 6662 patients

Interval laparoscopic appendectomy after antibiotic therapy for appendiceal abscess in elderly patients

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