Multicenter matched case-control study comparing laparoscopic surgery with open surgery for elderly colon and rectal cancer patients.

Abstract

e14091 Background: Laparoscopic surgery for colon cancer has gained acceptance due to advantages, although no clear equivalent evidences exist for the elderly patients. The aim of this study was to compare outcomes of open and laparoscopic colorectal surgery in patients aged 80 and above, and estimate the feasibility of laparoscopic surgery for the elderly patients. Methods: We conducted a matched case-control study using data from 41 hospitals, the member of Japan Society of Laparoscopic Colorectal Surgery. 2014 patients aged 80 and above underwent surgery for colon or rectal cancer between 2003 and 2007. Propensity score method was used to balance covariates between the surgery groups. Covariates included age, sex, BMI, ASA class, performance status, elective or emergency, previous abdominal surgery, tumor size, tumor site, T-stage, N-stage, and TNM stage. For the prediction model, calibration was assessed by the Hosmer-Lemeshow goodness-of-fit test. The primary end point was overall survival (OS). Secondary end points included disease-free survival (DFS), cancer-specific survival (CSS), and postoperative complications. Results: 1526 and 282 patients underwent surgery for colon and rectal cancer, respectively. The distribution of covariates was significantly different between the open surgery (OP) group and the laparoscopic surgery (LAP) group, in colon and rectal cancer. After propensity score matching, all covariates were balanced and no longer had significant differences, except for tumor size in colon cancer cases. There were 804 patients in 402 pairs managed with the OP or the LAP for colon cancer, and 114 patients in 57 pairs for rectal cancer. OS, DFS and CSS did not differ between the groups for either colon cancer (p = 0.916, 0.968 and 0.799 by log-rank test) or for rectal cancer (p = 0.765, 0.519, and 0.950). Overall morbidities were significantly fewer in the LAP group than in the OP group for colon cancer (24.9% vs. 36.3%, p < 0.001), and no difference for rectal cancer (47.4% vs. 40.4%, p = 0.450). Conclusions: The laparoscopic surgery was not inferior to the open procedure, and can be an acceptable alternative to open surgery for elderly patients with colon and rectal cancer.