Laparoscopic vs open colorectal cancer surgery in elderly patients: short- and long-term outcomes and predictors for overall and disease-free survival

Sicheng Zhou,Xishan Wang,Jianwei Liang,Qian Liu,Xuewei Wang,Chuanduo Zhao,Zhaoxu Zheng,Haitao Zhou,Zhixiang Zhou

doi:10.1186/s12893-019-0596-3

Sicheng Zhou, Xishan Wang + Show 7 more

Open Access

https://doi.org/10.1186/s12893-019-0596-3

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Abstract

BackgroundColorectal cancer is common in elderly patients. Laparoscopy is widely used to approach this kind of disease. This study was to examine short-term outcomes and long-term survival for laparoscopic and open surgery in elderly patients with colorectal cancer.MethodsFrom January 2007 to December 2018, patients with colorectal cancer older than 80 operated at China National Cancer Center were included in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between open and laparoscopic surgery was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed by Cox proportional hazard model.ResultsNinety-three pairs were selected after PSM. Patients in laparoscopic group had less intraoperative blood loss, postoperative complications, time to first flatus, time to oral feeding, postoperative hospital stay, and higher retrieved lymph node (P < 0.05). The OS and DFS rates were similar (P > 0.05), besides the CEA level, III/IV stage, and perineural invasion were independent predictors of survival (P < 0.05).ConclusionIn elderly patients with colorectal cancer, laparoscopic surgery had better short-term outcomes than open surgery. CEA level, III/IV stage, and perineural invasion were reliable predictors for OS and DFS.

Highlights

According to the Globocan 2012 database of the World Cancer Research Centre, the incidence of colorectal cancer in those over 75 years old in China is approximately 78,200 every year and it accounted for 18.08% of the global incidence [1]
Laparoscopic technique for colorectal cancer has been widely applied in clinical practice due to its advantages of small incision, quick recovery, and shorter hospitalization compared with open surgery [2,3,4]
disease-free survival (DFS) was significantly affected by the carcinoembryonic antigen (CEA) level (HR:1.77; 95% confidence interval (CI):1.29–4.15; P = 0.038), tumor nodes metastasis (TNM) stage (HR:9.67; 95% confidence interval (95% CI):3.18–79.30; P = 0.012), and the perineural invasion (HR:2.09; 95% CI:1.59–5.32; P = 0.020) (Table 3)

Summary

Introduction

According to the Globocan 2012 database of the World Cancer Research Centre, the incidence of colorectal cancer in those over 75 years old in China is approximately 78,200 every year and it accounted for 18.08% of the global incidence [1]. Laparoscopic technique for colorectal cancer has been widely applied in clinical practice due to its advantages of small incision, quick recovery, and shorter hospitalization compared with open surgery [2,3,4]. Its short-term results and long-term efficacy have been confirmed by a series of a large sample, multicenter randomized controlled studies [5,6,7,8]. Patients After approved by the ethics committee of Cancer Hospital, Chinese Academy of Medical Sciences (NCC 2017-YZ-026, Oct 17, 2017), all curatively operated colorectal cancer patients were collected between January 2007 and December 2018 at National Cancer Centre/National Clinical Research. Colorectal cancer is common in elderly patients. This study was to examine short-term outcomes and long-term survival for laparoscopic and open surgery in elderly patients with colorectal cancer

Results

Discussion

Conclusion