Shoichi Fujii, Phd, MD, Atsushi Ishibe, PhD, MD, Mitsuyoshi Ota, Phd, MD, Shigeru Yamagishi, PhD, MD, Kazuteru Watanabe, PhD, MD, Jun Watanabe, PhD, MD, Amane Kanazawa, MD, Yasushi Ichikawa, PhD, MD, Mari Saito, PhD, Satoshi Morita, Ph, D, Chikara Kunisaki, PhD, MD, Itaru Endo, PhD, MD
Yokohama City University Medical Center
(Background) In surgical treatment to the elderly patient who has the dysfunction of the main internal organs, coexisting of securing safety of surgery and the radical cure is a problem.
(Purpose) To verify safety and the validity of the laparoscopic surgery to the elderly patient’s colorectal cancer
(Patient and method) The laparotomy (Group O) and the laparoscopic surgery (Group L) were examined by randomized study in the cTis-T4a colorectal cancer patients who were 75 or more. The exclusion criteria were patients who had a bulky tumor larger than 8cm in diameter, lower rectal cancer that required pelvic side wall lymphadenectomy, and the past history of laparotomy of the colon resection. The makeup factor was the tumor location (right colon, left colon and rectum). The registration period was three years, and the scheduled number of patients was 200. The primary endpoint was short-term postoperative complication rate, and the secondary was 3-years relapse-free survival rate. The term and Grade of complication were classified by CTCAEver4.0.
(Result) The registration period was extended for one year. One hundred patients (right side 43, left side 28, and rectum 29) were registered in each group from August, 2008 to August, 2012, respectively. There were no differences between both groups in the patient’s factors such as age (80.1:79.8), gonad, the concomitant disease, ASAscore, cT, and f-Stage. There were no differences in the treatment factors such as procedure types and surgeon’s skill, too. The patients that were converted to open surgery in group L were 3 cases (3%). The reason for conversion was an uncontrollable bleeding, a peritoneum metastasis excision purpose, and patient’s hope immediately before the operation, respectively. In the short-term results (O: L), there were significant differences in Grade2 or more complication (%) (30:18), ileus (%) (12:4), the amount of bleeding (ml) (157:63) and operation time (min) (150:172), and the duration of postoperative hospital stay (days) (14.4:11.7). There was no significant difference in the pathological proximal margin (mm) (109:109), the distal margin (mm) (74:85), positive rate of circumferential margin (%) (4:3), the number of dissected lymph nodes (24.8:22.7), and the residual tumor rate (%) (95:99). In the examination according to the tumor location, there were significant differences in Grade2 or more complication (32.4:15.5), the amount of bleeding (135:42) and operation time (137:160), and the duration of postoperative hospital stay (13.0:10.0) in the colon cancer. There was a significant difference only in amount of bleeding (212:113) in the rectal cancer.
(Conclusion) The laparoscopic surgery to the elderly colorectal cancer patients did not have the difference in the radical cure compared with the open surgery and short-term results except the operation time were excellent. It is an effective therapeutic procedure for the elderly colorectal cancer patients.
Session: Podium Presentation
Program Number: S073