Abstract
Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were presented. Out of them, 66 patients underwent laparatomy and 40 patients underwent laparoscopy. Patients were matched for ASA and CR-PОSSUM scales, age-and body mass index, dis- ease stage and type of surgery. Results. The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min). Intraoperative blood loss was higher in patients treated by laparotomy than by laparoscopy (167 ml versus 109 ml), but the differences were insignificant (р=0.36). No differences in lymphodissection quality and adequate resection volume between the groups were found. The average hospital stay was not significantly shorter in the laparoscopic group (р=0.43). Complications occurred with equal frequency in both groups (13.6 % compared to 15.0 %). The median follow-up time was 16 months (range, 6-30 months). The number of patients died during a long-term follow-up was 2 times higher after laparotomic surgery than after laparoscopic surgery, however, the difference was not statistically significant. Conclusion. Postoperative compli- cations in elderly patients with colorectal cancer did not exceed the average rates and did not depend on the age. Both groups were matched for the intraoperative bleeding volume and quality of lymphodenectomy. Significantly shorter duration of laparoscopic surgery was explained by the faster surgical access however, it showed no benefit in reducing the average length of hospital stay and decreasing the number of complications. The choice of surgi- cal access had no impact on life quality of patients after treatment. There was a tendency toward an increase in the percentage of deaths in a long-term follow-up due to causes not related to colorectal cancer, thus, resulting in the decreased overall survival rate in elderly patients treated by laparatomy.
Highlights
The patient’s age is one of the major risk factors of death from colorectal cancer
The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer
The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min)
Summary
Данные национального регистра Франции свидетельствуют о том, что среди больных КРР старше 75 лет радикальной операции подвергаются только 34 %, в то время как среди пациентов более молодого возраста – 53 % [18]. В двух работах немецких авторов на основе данных 569 и 517 больных, разделенных по возрастным группам старше и моложе 75 лет, было установлено, что возраст больного не влияет на отдаленные результаты хирургического лечения КРР, а основными прогностическими факторами исхода операции являются стадия заболевания и паллиативный или радикальный характер вмешательства [31, 33]. Включивший в себя 18 рандомизированных исследований и данные более 6 000 больных КРР, показал достоверное снижение числа кардиологических осложнений и тенденцию к уменьшению доли осложнений со стороны дыхательной системы при эндовидеохирургическом доступе, что позволяет рекомендовать эту методику для лечения лиц пожилого и старческого возраста [34]. Предоперационное обследование включало клинические и биохимические анализы, коагулограмму, Характеристики сравниваемых групп
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