Is the benefit of laparoscopy maintained in elderly patients undergoing rectal cancer resection? An analysis of 446 consecutive patients.

Abstract

Several studies showed that age is significantly associated with impaired outcomes after open colorectal surgery. However, very few data exist on laparoscopic rectal cancer surgery in elderly patients. The aim of this study was to assess operative results of laparoscopic rectal cancer surgery according to age. From 2005 to 2014, 446 consecutive patients who underwent laparoscopic rectal cancer resection were identified from a prospective database. Five groups were defined: age <45 (n=44), 45-54 (n=80), 55-64 (n=166), 65-74 (n=95) and ≥75years (n=61). Elderly patients presented significantly higher ASA score (p=0.004), higher Charlson comorbidity index (p<0.0001) and more frequent cardiovascular, pulmonary (p<0.0001) and neurological (p=0.03) comorbidities. Overall postoperative morbidity rate was similar between groups (34-35-37-43-43%, p=0.70). Medical morbidity slightly increased with age (14-9-14-19-26%, p=0.06), but there was no significant difference regarding clinical anastomotic leakage, surgical morbidity, major morbidity (Dindo ≥3), cardiopulmonary complications and length of hospital stay. In multivariate analysis, age was not an independent factor for postoperative morbidity, unlike ASA score ≥3 (p=0.039), neoadjuvant radiotherapy/chemoradiotherapy (p=0.034) and operative time ≥240min (p=0.013). This study showed that laparoscopic rectal cancer resection might safely be performed irrespective of age.