Is laparoscopic colectomy for cancer really beneficial in octogenarians?

Leonardo de Castro Duraes, PhD, MD1, Luca Stocchi, MD1, Meagan Costedio, MD1, David Dietz, MD1, Emre Gorgun, MD1, Matthew F Kalady, MD1, Herman Kessler, MD1, Xiaobo Liu2, Feza Remzi, MD1. 1Colorectal Surgery Department – Digestive Disease Institute – Cleveland Clinic Foundation, Ohio, 2Quantitative Health Sciences – Lerner Research Institute – Cleveland Clinic Foundation, Ohio

Background:

Laparoscopic colectomy for cancer is associated with recovery benefits and similar oncologic outcomes when compared to open procedures. Octogenarians are a special segment of the population in which the use of laparoscopy has not been well established. The aim of this study was to compare outcomes after laparoscopic vs. open surgery with curative intent for colon cancer in octogenarians.

Methods:

An institutional database was queried to identify patients older than 80 years-old with stages I-III colon adenocarcinoma, operated with curative intent between 2000 and 2012. Exclusion criteria were emergency surgery, inflammatory bowel disease, hereditary colorectal neoplasm, and other malignancies. Univariate, multivariate, and Kaplan-Meier survival analyses were performed to compare perioperative and oncologic outcomes of laparoscopic colectomy vs. open colectomy and assess possible association with a number of patient-related, disease-related and treatment-related factors. P<0.05 was considered statistically significant.

Results:

225 patients fulfilled the inclusion criteria. Laparoscopy was used in 27.1% of the procedures. The conversion rate was 16.4%. Patients treated with laparoscopy were significantly older than patients treated with open surgery. There were otherwise no differences in gender, BMI, ASA and pathological stage between the groups. Perioperative morbidity, mortality and oncological outcomes were also comparable. Patients undergoing laparoscopic surgery had reduced length of hospital stay when compared with the open group (p=0.033). Multivariate analysis indicated male gender (OR=1.87, 95% CI, 1.03-3.40, p=0.03) as the only independent factor associated with increased morbidity, while pathological stage III (OR=7.28, 95% CI, 1.53-34.61, p=0.01) was the only independent factor associated with cancer-specific survival.

Conclusion:

Laparoscopy can be safely offered to selected octogenarians for treatment of colon cancer with curative intent and is associated with recovery benefits.

Laparoscopy Open p Value
Patients 61 164
Age(mean/sd) 85.7(3.7) 84.5(3.6) 0.019
Gender – Male n(%) 28(45.9) 70(42.7) 0.67
BMI(mean/sd) 25.9(4.0) 25.6(4.6) 0.276
Pathological Stage n(%) 0.26
Stage I 20(32.8) 37(22.6)
Stage II 26(42.6) 75(45.7)
Stage III 15(24.6) 52(31.7)
Complications
Overall 28(45.9) 55(33.5) 0.087
Intraoperative 2(3.3) 10(6.1) 0.40
Postoperative 27(44.3) 52(31.7) 0.079
30 day mortality n(%) 2(3.3) 13(7.9) 0.21
5-year Overall Survival (95% CI) 42.2%(19.1%-65.3%) 42.1%(33.8%-50.3%) 0.115
5-year Disease Free Survival (95% CI) 39.5%(17.5%-61.5%) 39.8%(31.6%-48.0%) 0.126
5-year Cancer Specific Survival (95% CI) 90.0%(76.5%-100%) 85.2%(78.2%-92.2%) 0.325
5-year Overall Recurrence (95% CI) 19.1%(4.1%-34.1%) 11.7%(5.5%-17.8%) 0.767
Length of stay (days) – median, mean(sd) 7, 9.1(8.1) 8, 10.2(6.9) 0.033

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