Hirohisa Miura, Atsuko Tsutsui, Naoto Ogura, Masanori Naito, Takeo Sato, Takatoshi Nakamura, Masahiko Watanabe
School of Medicine,Kitasato University
Background: Laparoscopic colectomy has been acknowledged to be a minimally invasive procedure. On the other hand, open surgery is often selected for very elderly patients to shorten operation time.In recent years, however, improvements in surgical techniques have shortened operation times, leading to the increased use of laparoscopic surgery in even very elderly patients.
Objective: To clarify the feasibility of laparoscopic colectomy in very elderly patients.
Subjects and Methods: The study group comprised 97 patients with colorectal cancer who were 80 years or older and underwent surgery in our hospital from January 2004 through December 2011. The patients were divided into 2 groups according to whether they underwent open surgery or laparoscopic surgery, and short-term outcomes were compared.
Results: There were 50 men (51.5%) and 47 women (48.5%). The mean age was 83.3 years. Sixty-six patients (68.0%) were 80 to 84 years old, 27 (27.8%) were 85 to 89 years old, and 4 (4.1%) were 90 years or older. Preoperative complications included cardiac disease in 45 patients (46.4%), lung disease in 8 (8.2%), cerebrovascular disease in 7 (7.2%), renal disease in 9 (9.3%), arterial disease in 8 (8.2%), and malignant tumors in 9 (9.3%).The surgical procedure was open surgery in 37 patients (38.1%) and laparoscopic surgery in 60 (61.9%).The American Association of Anesthesiologists (ASA) physical status classification was class I in 3 patients (3.1%), class II in 57 (58.8%), and class III in 37 (38.1%). Laparoscopic surgery was associated with significantly less intraoperative blood loss than open surgery (p = 0.0021).The operation time (p = 0.896), length of hospital stay (p = 0.089), degree of dissection (p = 0.293), and number of lymph-node metastases examined (p = 0.093) did not differ between the groups. Postoperative complications occurred in 31 patients (32.0%), 15 (40.5%) in the open surgery group and 16 (26.7%) in the laparoscopic surgery group.In the open surgery group, wound infection occurred in 7 patients (18.9%), suture failure in 5 (13.5%), ileus in 1 (2.7%), anastomotic hemorrhage in 1 (2.7%), and pneumonia in 1 (2.7%).In the laparoscopic surgery group, wound infection occurred in 7 patients (11.7%), suture failure in 0, ileus in 4 (6.7%), anastomotic hemorrhage in 1 (1.7%), pneumonia in 3 (5.0%), and cardiac disease in 1 (1.7%). The differences between the groups were not significant (p = 0.398).
Conclusions: Laparoscopic colectomy is a valid option for very elderly patients with colorectal cancer.
Session: Poster Presentation
Program Number: P086