高齢者大腸癌患者における腹腔鏡補助下手術の検討

Abstract

This study evaluated the safety and efficacy of laparoscopic surgery in elderly colorectal cancer patients. A total of 270 colorectal cancer patients over 75 years old who had undergone laparoscopy-assisted colectomy (LAC, 81 patients) or open colectomy (OC, 189 patients) between 2000 and 2009 were retrospectively analyzed regarding clinicopathological and surgery-related factors, perioperative course and pre- and postoperative complications. Early cancers or smaller tumors were treated more frequently by LAC than by OC. LAC tended to take a longer operative time but was similar to OC in terms of the degree of lymph node dissection and number of lymph nodes. The LAC group showed less blood loss, earlier ambulation, earlier eating and drinking, earlier passage of flatus and feces, a shorter hospital stay and lower postoperative leukocyte count (days 1 and 3) and CRP (day 3). The LAC group was similar to the OC group in preoperative complications (80.2% vs. 81.1%) but less postoperative complications (6.7% vs. 12.2%). The postoperative complications were mainly deliria and respiratory complications, but there was no anastomotic leakage or operative deaths. LAC was relatively safe in elderly patients and is associated with earlier postoperative recovery. The abdominal wall damage caused by surgery was considered one reason for the delay of patient recovery. LAC showed reduced damage and better postoperative course. These results indicate expanded indications of LAC for elderly colon cancer patients.