Laparoscopic Versus Open Surgery for Colorectal Cancer in Elderly Patients: Does History of Abdominal Surgery Influence the Surgical Outcome?

Seiichiro Yamamoto, MD, PhD¹, Takao Hinoi, MD, PhD², Hiroaki Niitsu, MD¹, Minoru Hattori², Ichio Suzuka, MD³, Yosuke Fukunaga⁴, Takashi Yamaguchi, MD⁵, Masazumi Okajima, MD, PhD⁶, Hideki Ohdan¹, Masahiko Watanabe, MD, PhD⁷. ¹Hiratsuka City Hospital, ²Hiroshima University, ³Kagawa Prefectural Center Hospital, ⁴Cancer Institute Hospital, ⁵Kyoto Medical Hospital, ⁶Hiroshima City Hiroshima Citizens Hospital, ⁷Kitasato University School of Medicine

Introduction: Several reports suggested that the laparoscopic surgery (LS) is not inferior to the open surgery (OS), and that LS can be an acceptable alternative to OS in elderly patients with colon and rectal cancer. However, safety and feasibility of LS in elderly patients with past history of abdominal surgery has not yet been established. To examine the technical and oncological feasibility of LS in elderly patients with past history of abdominal surgery, we conducted a propensity scoring matched case–control study.

Patients and Methods: The present study included data that were collected in the multicenter, case-controlled study entitled “Retrospective study of laparoscopic colorectal surgery for elderly patients”, which aimed to assess the safety and efficacy of laparoscopic colorectal cancer surgery in patients ≥80 years old. Forty-one member hospitals of the Japan Society of Laparoscopic Colorectal Surgery participated in the study, and 2065 elderly patients who underwent LS or OS between January 2003 and December 2007 were enrolled. Of these, we included 587 patients who had history of abdominal surgery, and received curative and elective surgery for stage 0 to III CRC. Of all included patients, 408 patients received OS, and 179 received LS. After matching, 153 patients were included in each cohort. Surgical outcomes were compared between LS and OS. Because the current study is retrospective nature, propensity scores were used to match members of the LS and OS groups. The P-value <0.05 was determined statistically significant.

Results: LS resulted in significantly longer surgical duration (220 minutes vs 170 minutes, p<0.001), but significantly less blood loss (39 vs 100 ml, p<0.001), while there were no significant differences in number of surgical procedure harvested lymph node, and resection margin between the two groups. Postoperative recovery including length of stay (12 vs 14 days, p=0.002), and days to fluid (2 vs 3 days, p<0.001) and solid diet (4 vs 5 days, p<0.001), were significantly faster in the LAP group. Moreover, overall morbidity (43 vs 66 percent, p=0.009) and postoperative ileus (7 vs 19 percent, p=0.023) were significantly less observed in the LAP group while other morbidities were not significant. In the survival analyses, overall survival and disease-free survival were not different between the two groups.

Conclusion: In elderly colon and rectal cancer patients with past history of abdominal surgery, LS can be performed safely, and LS group tended to show lower postoperative morbidity than OS group.