Effect of Age and Comorbidities on Short- and Long-Term Results in Patients Undergoing Laparoscopic Curative Resection for Rectal Cancer.

Abstract

Conflicting findings have been reported in older patients undergoing laparoscopic surgery for rectal cancer. The aim of this study was to evaluate the effects of age and comorbidities on short- and long-term results of patients undergoing laparoscopic curative resection for rectal cancer (LCRRC). We retrospectively evaluated all 173 consecutive patients undergoing LCRRC at our unit (June 2005-September 2015). They were divided into two age groups as follows: <75 (n = 122) and ≥75 (n = 51) years. Comorbidities were evaluated using American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and age-related Charlson Comorbidity Index (ACCI). Tumor characteristics were similar in the two groups. Comorbidity status (ASA, CCI, ACCI) was worse in elderly patients. Type of surgery performed was similar in the two groups. Medical complications were significantly higher in elderly (10.7% versus 29.4%, P = .006), while surgical complications were similar. Postoperative stay was longer in older patients (13 days versus 9 days, P = .0007). Multivariable analysis identified older age, higher CCI, and longer operative time as independent predictors of morbidity. Five years overall survival and disease-free survival were 49% and 43% in older and 84% and 77% in younger group (P < .0001). Multivariable analysis identified age, CCI, tumor, node, metastasis stage, and postoperative morbidity as independent risk factors for overall and disease-free survival. LCRRC achieves excellent short- and long-term results, but age and comorbidities may significantly affect postoperative morbidity and survival.