Surgical Outcomes of Laparoscopic Right Colectomy in Octogenarians

Ron Shapiro, MD1, Uri Keler, MD1, Hatib Kamal, MD2, Guy Pascal, MD2, Aviram Nissan, MD1, David Hazzan, MD2. 1Chaim Sheba Medical Center, 2Carmel Medical Center

Introduction: Surgical morbidity rates are higher in the elderly when compared to younger age groups. The aim of this study was to evaluate the impact of age on operative results of laparoscopic right hemicolectomy.

Methods: This is a comparative study, according to age groups, of patients who underwent laparoscopic right hemicolectomy for neoplasm of the right colon. Patients were divided into three groups: age< 65 years (GroupA) age 65-79 (GroupB) and age> 80 years (GroupC). Short and long-term outcomes were compared. T-Test was used for continuous variables and Chi Square was used for analysis of categorical variables.

Results: 207 consecutive patients were included in the study, 48 in group A, 105 in group B and 54 in group C. There was no statistically significant difference in the groups in terms of BMI and gender. Octogenarians (GroupC) included a higher proportion of patients with existing comorbidities (GroupC- 70.4%, GroupB- 54.3%, GroupA- 35.4%, p=0.002), higher proportion of patients with ASA 3 and above (GroupC- 70.4%, GroupB- 52.4%, GroupA- 33.3%, p=0.001), and a higher proportion of patients operated on for colon cancer as well as patients with existence of other active malignancy. There was no difference between the groups in the extent of the operation performed (Right colectomy vs. extended right colectomy) and anastomosis technique (intracorporeal vs. extracorporeal). The operative time was shorter in the Octogenarians group (GroupC- 139 minutes, GroupB- 147 minutes, GroupA- 159 minutes, p=0.036). Octogenarians (GroupC) needed more blood transfusions (GroupC- 9.3%, GroupB- 0%, GroupA- 2.1%, p=0.005). There was no statistically significant difference between the groups in overall rate of postoperative morbidity and mortality. Intra-abdominal infection (leak+abscess) rate was higher in the youngest age group (GroupA) (GroupA- 8.3%, GroupB- 1%, GroupC- 1.9%, p=0.035). However, this did not result in differences between the groups in terms of need for re-intervention and the Clavien-Dindo score. Length of stay was longer in octogenarians (GroupC- 7 days, GroupB- 6.1 days, GroupA- 6 days, p=0.002). There was no statistically significant difference in the occurrence of long-term complications, namely small bowel obstruction and incisional hernia. Nevertheless, there was a trend towards a higher incisional hernia rate in octogenarian (GroupC- 18.5%, GroupB- 7.6%, GroupA- 6.3%, p=0.061).

Conclusions: Laparoscopic right hemicolectomy does not result in increased morbidity and mortality in octogenarians. Nevertheless, a longer recovery time should be expected when compared to younger age groups.

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