Laparoscopic Cholecystectomy in Japanese Octogenarians

Abstract

Purpose: The most rapidly growing sector of Japanese society is composed of individuals older than 65 years of age and by 2050 this age group will represent 35.7% of the population. For the elderly, who are generally considered to have diminished cardiopulmonary reserves and who are therefore often less able to withstand the trauma and stress of open abdominal surgery, the advantages of a laparoscopic approach are obvious. However, elderly patients may have an increased risk of conversion to open cholecystectomy and individuals aged 80 years and over are at the greatest risk of experiencing adverse surgical outcomes. The purpose of this study was to evaluate the results of laparoscopic cholecystectomy (LC) in patients aged 80 years and over. Methods: Between April 1992 and December 2003, 471 patients aged 65 to 79 years (Group 1) and 45 patients aged 80 years and over (Group 2), who underwent LC were included in the study. Laparoscopic exploration of the common bile duct could be performed both to obtain a diagnosis or for the treatment. Results: The mean age of Group 1 patients (202 men and 269 women) was 71 years; the mean age of Group 2 patients (18 men and 27 women) was 83 years. Choledocholithiasis and gallbladder cancer were both significantly more common in Group 2 patients. Hypertension, diabetes mellitus, and cardiovascular disease were the most common underlying diseases in both groups. There were no deaths in either group. The overall incidence of major complications (bile duct injury, bile leakage and bowel injury) was low and similar in the two groups. The success rate of the intraoperative cholangiography was similar between groups, however the rate of laparoscopic stone clearance was significantly higher in Group 2 patients. Cholesterol stones were the most frequently reported type of stone in both groups. Seventy-five of the 221 patients (34%) in Group 1, and 14 of the 20 patients (70%) in Group 2, had positive bile cultures (p = 0.003). The incidence of GNRs in Group 2 patients was significantly higher than in Group 1 patients. Conclusions: Octogenarians tolerate LC well, especially in the elective setting. Therefore, primary care physicians should feel comfortable when referring patients for the surgical management of biliary tract disease before complications might develop that would necessitate an urgent operation.