Laparoscopic Right Colectomy Is Advantageous Over Conventional Open Surgery in Elderly Patients

Catherine Beaumier, BPharm, Yves Bendavid, MD, Margaret Henri, MD, Francoise Heyen, MD, Jean-François Latulippe, MD, Madeleine Poirier, MD. Hopital Maisonneuve-Rosemont

Introduction: In many practices, laparoscopy has become the approach of choice for patients undergoing colectomy for benign disease or malignancy. Results of studies show better early outcomes-length of stay and return of bowel function-in patients undergoing laparoscopic rather than open colectomy. Are these advantages still present in the elderly population? The goal of our study was to determine if laparoscopy is advantageous for patients over 70 years undergoing right colectomy.

Methods: A retrospective analysis was conducted between August 2003 – December 2008. A search was performed in the computerized medical records system of our institution, a tertiary academic hospital. All patients having undergone open or laparoscopic right hemicolectomy were included. Exclusion criteria were ileo-cecal resection, subtotal colectomy and stoma creation during surgery. Patient demographics, operative indication, blood loss, operative time, post-operative analgesia requirements, return of bowel function, hospital length of stay and early surgical outcomes, were compared between the two groups. Statistical analysis was performed using the Student’s t-test and statistical significance set at a level of 0.05.

Results: Between August 2003 and December 2008, 198 patients underwent either a right hemicolectomy (174), or an extended right hemicolectomy (24). The male to female ratio was 1.13:1 and the median age was 72.5 years. Open right hemicolectomy (ORH) was performed in 138 cases and laparoscopic right hemicolectomy (LRH) in 60. The more common indications were colonic cancer (155) and polyp (26), while diverticulitis, inflammatory bowel disease, volvulus and bowel ischemia accounted for the remaining cases. When compared to ORH, LRH provided the patients with faster return of bowel function (LRH mean =3.3d 95% CI[2.9-3.7]; ORH mean=4.8d 95% CI[4.4-5.2]; p<0.0001) and reduced the amount of post-operative analgesia (as mesured in equivalent of subcutaneous morphine) required (LRH mean=51.5mg 95%CI[31.5-71.5]; ORH mean=156.8mg 95%CI[93.1-220.5]; p=0.0002). The incidence of mortality and complications such as anastomotic leakage, delirium, transfusion, wound infection, intraabdominal abcess were comparable.

Conclusion: In this geriatric population, LRH was found to be as safe and effective as ORH. Moreover, in our elderly population, LRH reduced postoperative pain, as shown by the postoperative analgesia reduced to a third when compared to ORH, and afforded an earlier return of bowel function. More studies are required to confirm that LRH may be the approach of choice in the elderly population.