Koetsu Inoue, MD, PhD1, Tatsuya Ueno, MD, PhD1, Orie Suzuki, MD1, Kentoro Shima, MD, PhD1, Shinji Goto, MD, PhD1, Michinaga Takahashi, MD, PhD1, Masanori Morikawa, MD, PhD2, Takeshi Naitoh, MD, PhD, FACS2, Hiroo Naito, MD, PhD, FACS1. 1Department of Surgery, South Miyagi, Medical Center, 2Department of Surgery, Tohoku University Graduate School of Medicine
Background: As average lifespan has become longer, laparoscopic colorectal surgery (Lap-CS) has been also applied to elderly patients (Pts). Elderly Pts, however, often have comorbidity such as heart, pulmonary, and metabolic diseases. Indication of Lap-CS to elderly Pts is still controversial, because laparoscopic operation usually require long time and increased intraabdominal pressure, both of which might be related to postoperative morbidity. Aim of this study is to assess safety and validity of Lap-CS for elderly Pts.
Method: Medical records of 192 Pts who underwent Lap-CS since 2003 to 2016, were retrospectively reviewed. Pts were divided into two groups by age; group A (>80), and group B(<80), and we compared Pts preoperative general condition and peri-operative outcomes between two groups. Two-tailed Student’s test and/or Pearson’s chi-square test were used for statistical analysis.
Results: There were 29 and 163 Pts in Groups A and B, respectively. There were no significant differences in male/female ratio and body mass index between two groups. Number of Pts whose ASA physical status was >3, and/or performance status was>2, were greater in group A (ASA; 34.5 vs 18.4%, p=0.049, PS; 20.7 vs 4.9%, p=0.003). Serum albumin level was significantly lower in group A (4.04 vs 4.34 g/dl, p=0.001).The location of tumor was follows; cecum (17.2 vs 8.6%, p=0.15), ascending colon (20.7 vs 15.9%, p=0.528), transverse colon(10.3 vs 4.9%, p=0.246), descending colon (0 vs 3.7%, p=0.294), sigmoid colon (10.3 vs 20.2%, p=0.208), rectum (17.2 vs 38.0%, p=0.030).
The rate of patients who was advanced colorectal cancer did not differ (48.3 vs 51.5%, p=0.746). Intra-operative blood loss, operating time, and number of harvested lymph nodes did not differ between the two groups. As for postoperative complications such as postoperative ileus (3.4 vs 5.5%, p=0.643), intra-abdominal abscess (3.4 vs 1.2%, p=0.374), anastomotic leakage (0 vs 6.1%, p=0.17), significant difference was not observed between the two groups. Incidence of Clavien-Dindo classification > grade 3, and postoperative hospital stay did not differ. The mortality was 0% in both groups.
Conclusion: Short-term outcomes of Lap-CS in elderly Pts were not different from those in young Pts in site of poor preoperative general condition in elderly Pts. These results suggests that Lap-CS could be an alternative operation indicated for Pts with comorbidities.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77932
Program Number: P270
Presentation Session: Poster (Non CME)
Presentation Type: Poster