Age and comorbidities do not affect short-term outcomes after laparoscopic rectal cancer resection in elderly patients. A multi-institutional cohort study in 287 patients

Roberto Peltrini,Umberto Bracale,Francesco Corcione,Diego Cuccurullo,Marco Caricato,Gabriella Teresa Capolupo,Filippo Carannante,Nicola Imperatore

doi:10.1007/s13304-021-00990-z

Abstract

Postoperative complications and mortality rates after rectal cancer surgery are higher in elderly than in non-elderly patients. The aim of this study is to evaluate whether, like in open surgery, age and comorbidities affect postoperative outcomes limiting the benefits of a laparoscopic approach. Between April 2011 and July 2020, data of 287 patients with rectal cancer submitted to laparoscopic rectal resection from different institutions were collected in an electronic database and were categorized into two groups: < 75 years and ≥ 75 years of age. Perioperative data and short-term outcomes were compared between these groups. Risk factors for postoperative complications were determined on multivariate analysis, including age groups and previous comorbidities as variables. Seventy-seven elderly patients had both higher ASA scores (p < 0.001) and cardiovascular disease rates (p = 0.02) compared with 210 non-elderly patients. There were no significative differences between groups in terms of overall postoperative complications (p = 0.3), number of patients with complications (p = 0.2), length of stay (p = 0.2) and death during hospitalization (p = 0.9). The only independent variables correlated with postoperative morbidity were male gender (OR 2.56; 95% CI 1.53–3.68, p < 0.01) and low-medium localization of the tumor (OR 2.12; 75% CI 1.43–4.21, p < 0.01). Although older people are more frail patients, short-term postoperative outcomes in patients ≥ 75 years of age were similar to those of younger patients after laparoscopic surgery for rectal cancer. Elderly patients benefit from laparoscopic rectal resection as well as non-elderly patient, despite advanced age and comorbidities.

Highlights

Treatment of locally advanced mid or low rectal cancer is based on neoadjuvant chemoradiation followed by total mesorectal excision (TME) [1]
Several randomized controlled trials (RCTs) and metaanalyses [5,6,7,8,9] demonstrated the safety of laparoscopic rectal cancer surgery, better functional recovery and oncological outcomes comparable to open surgery
No statistically significant differences between groups were noted for the location of the cancer, the preoperative T stage and the proportion of patients who underwent neoadjuvant chemoradiation

Summary

Introduction

Treatment of locally advanced mid or low rectal cancer is based on neoadjuvant chemoradiation followed by total mesorectal excision (TME) [1]. While it is considered appropriate to apply the same ’standard of care’ to this category of patients, the increased risk of postoperative complications and mortality must be considered in patients with coexisting comorbidities and reduced physiological reserve capacity [4]. In this regard, advanced age should not represent itself a reason for exclusion of patients from radical surgery, but rather the frailty of these patients themselves is to be considered a primary risk factor [2, 3]. Despite it is well known that the number of elderly patients is poorly represented in clinical trials, underestimating the ’real-life data’ [10,11,12], laparoscopic colorectal surgery has significant advantages in short-term outcomes in the elderly population [13,14,15]

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Conclusion