Abstract
Simple SummaryAs the effect of laparoscopic surgery on elderly patients with colorectal cancer (CRC) remains unclear, this propensity score–weighted cohort study revealed that laparoscopic surgery is a favorable method for elderly patients with CRC than open surgery in terms of less pulmonary-related postoperative morbidity and mortality, less hospital stay and similar oncological outcomes.Advanced age is a risk factor for major abdominal surgery due to a decline in physical function and increased comorbidities. Although laparoscopic surgery provides good results in most patients with colorectal cancer (CRC), its effect on elderly patients remains unclear. This study aimed to compare the short- and long-term outcomes between open and laparoscopic surgeries in elderly patients with CRC. Total 1350 patients aged ≥75 years who underwent curative resection for stage I–III primary CRC were enrolled retrospectively and were divided into open surgery (846 patients) and laparoscopy (504 patients) groups. After propensity score weighting to balance an uneven distribution, a competing risk analysis was used to analyze the short-term and long-term outcomes. Postoperative mortality rates were lower in the laparoscopy group, especially due to pulmonary complications. Postoperative hospital stay was significantly shorter in the laparoscopy group than in the open surgery group. Overall survival, disease-free survival, and competing risk analysis showed no significant differences between the two groups. Laparoscopic surgery for elderly patients with CRC significantly decreased pulmonary-related postoperative morbidity and mortality in this large cohort study. Laparoscopic surgery is a favorable method for elderly patients with CRC than open surgery in terms of less hospital stay and similar oncological outcomes.
Highlights
The incidence of colorectal cancer (CRC) increases with age, and data from several populations indicate that approximately 40% of CRC cases occur in patients aged >75 years [1,2,3]
The laparoscopic group had a greater proportion of patients with higher body mass index (BMI), less previous colorectal surgery, comorbidity of hypertension, preoperative carcinoembryonic antigen < 5 ng/mL, serum albumin level > 3.5 mg/dL, early tumor stage, well-differentiated histologic grade, retrieved lymph node > 12, and smaller tumor size compared with the open group
The postoperative hospital stay was significantly shorter in the laparoscopic group both before and after propensity score weighting (PSW)
Summary
The incidence of colorectal cancer (CRC) increases with age, and data from several populations indicate that approximately 40% of CRC cases occur in patients aged >75 years [1,2,3]. Some studies have reported that elderly patients undergoing open colorectal surgery are associated with high mortality (2.1–7.9%) and morbidity (17.7–50.0%) when compared with younger people [4,5,6]. Many randomized control trials, such as COST, CLASICC, COLOR, and COREAN have demonstrated that laparoscopic surgery has similar long-term outcomes and morbidity/mortality rates, but better short-term outcomes [7,8,9,10]. Because elderly patients who undergo laparoscopic surgery can return to their regular lives faster, whether these advantages can further improve their long-term prognosis remains unclear Few prospective studies have compared laparoscopic surgery with open surgery in elderly patients, especially focusing on long-term outcomes [14]
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