Yu Sato, MD, Giovanna DaSilva, MD, Eric G Weiss, Steven D Wexner, MD. Cleveland Clinic Florida
Background: Laparoscopic surgery for colorectal cancer in elderly and high-risk patients has proven to be safe and beneficial, with more favorable short-term results. This study evaluated the impact of co-morbidities in the short-term outcomes of elderly patients undergoing laparoscopic resection for colorectal cancer.
Methods: After IRB approval, 303 consecutive patients >65 years of age who underwent curative laparoscopic resection for colorectal cancer between January 2000 and June 2014 were included. Co-morbidity was quantified by using the Charlson Comorbidity Index (CCI). Low risk (CCI?2, Group A, n=149) and high-risk (3?CCI, Group B, n=154) patients were compared relative to short-term outcomes.
Results: Group A included 87 males/62 females with a mean age of 75.6 (range, 65-93) years; the majority had right-sided tumors and stage 3 cancers [51 (34%) and 46 (30.8%), respectively]. Group B included 100 males/54 females with a mean age of 76.9 (range, 65-96) years; the majority had right-sided tumors and stage 3 cancers [65 (42.2%) and 54 (35%), respectively]. Overall, there were 302 comorbities (23 in Group A, 279 in Group B). The most common were myocardial infarction (7 and 66, respectively), chronic pulmonary disease (6 and 44, respectively), diabetes (3 and 47, respectively), and peripheral vascular disease in (3 and 30, respectively) (p<0.05 for all). There were no significant differences in the number of lymph nodes dissected, mean operative time, or blood loss between the two groups. The number of transfused patients (13.1% vs. 21.1%; P=0.09), complication rate (56.1% vs. 66.9%; P=0.059), and length of postoperative stay (7.8 vs. 9.1 days; P=0.071) tended to be higher in Group B, but also not statistically significant.
Conclusions: Laparoscopic surgery for colorectal cancer in elderly patients with a high co-morbidity index can be performed safely and without increasing short-term complications and postoperative hospital stay.