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Laparoscopic Versus Open Surgery for Rectal Cancer in Elderly Patients

Received: 8 April 2016    Accepted:     Published: 9 April 2016
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Abstract

With the increase of life expectancy, surgical intervention for rectal cancer is more and more frequently performed in the elderly. It is well accepted that laparoscopic surgery is of advantage, but not widely recognized in old patients with rectal cancer. In order to assess laparoscopic surgery for rectal cancer in elderly patients, we performed this study. This retrospective study was designed to compare short-term outcomes between laparoscopic surgery and open surgery in elderly patients with rectal cancer, which may give some useful guidance in the clinical practice. Thirty-seven patients with rectal cancer aged 75 and older undergoing laparoscopic surgery were matched with 37 counterparts undergoing open surgery. Criteria of matching included general information and preoperative status. Patients in the laparoscopic surgery and open surgery groups were comparable for the matching criteria. Compared with the open surgery group, estimated blood loss (P=0.048) and intraoperative transfusion (P=0.042) were less in the laparoscopic surgery group. As to short-term postoperative outcomes, duration of postoperative hospital stay was shorter (P = 0.039) and overall complication (P = 0.032) and wound complication (P = 0.038) was less in the laparoscopic surgery group than in the open surgery group. In conclusion, considering the operative variables and short-term outcomes, laparoscopic surgery is safe and seems superior to open surgery in elderly patients with rectal cancer. However, further studies with more patients are needed to confirm the results and assess long-term results.

Published in Journal of Surgery (Volume 4, Issue 2)
DOI 10.11648/j.js.20160402.15
Page(s) 27-30
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Laparoscopic Surgery, Open Surgery, Elderly Patients, Rectal Cancer

References
[1] Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M, Wan X, Yu S, Jiang Y, Naghavi M, Vos T, Wang H, Lopez AD, Murray CJ. Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010. LANCET 2013; 381: 1987-2015.
[2] U.S. Bureau of the Census (2008) Annual estimates of the resident population by sex and five-year age groups for the United States. Retrieved 21 July 2009 at http://www.census.gov/popest/national/asrh/NC-EST2008/NC-EST2008-01.xls. Vintage 2008.
[3] Levi F, Lucchini F, Negri E, Boyle P, La Vecchia C. Changed trends of cancer mortality in the elderly. ANN ONCOL 2001; 12: 1467-1477.
[4] Folprecht G, Cunningham D, Ross P, Glimelius B, Di Costanzo F, Wils J, Scheithauer W, Rougier P, Aranda E, Hecker H, Kohne CH. Efficacy of 5-fluorouracil-based chemotherapy in elderly patients with metastatic colorectal cancer: a pooled analysis of clinical trials. ANN ONCOL 2004; 15: 1330-1338.
[5] Franceschi S, La Vecchia C. Cancer epidemiology in the elderly. Crit Rev Oncol Hematol 2001; 39: 219-226.
[6] Ng O, Watts E, Bull CA, Morris R, Acheson A, Banerjea A. Colorectal cancer outcomes in patients aged over 85 years. Ann R Coll Surg Engl 2016; 98: 216-221.
[7] Braendegaard WS, Baatrup G, Pfeiffer P, Qvortrup C. Trends in colorectal cancer in the elderly in Denmark, 1980-2012. ACTA ONCOL 2016; 55 Suppl 1:29-39.
[8] Whittle J, Steinberg EP, Anderson GF, Herbert R. Results of colectomy in elderly patients with colon cancer, based on Medicare claims data. AM J SURG 1992; 163: 572-576.
[9] Longo WE, Virgo KS, Johnson FE, Oprian CA, Vernava AM, Wade TP, Phelan MA, Henderson WG, Daley J, Khuri SF. Risk factors for morbidity and mortality after colectomy for colon cancer. DIS COLON RECTUM 2000; 43: 83-91.
[10] Black P, Kathiresan S, Chung W. Meningioma surgery in the elderly: a case-control study assessing morbidity and mortality. Acta Neurochir (Wien) 1998; 140: 1013-1016, 1016-1017.
[11] de Campos-Lobato LF, Alves-Ferreira PC, Geisler DP, Kiran RP. Benefits of laparoscopy: does the disease condition that indicated colectomy matter? Am Surg 2011; 77: 527-533.
[12] Law WL, Chu KW, Tung PH. Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg 2002; 195: 768-773.
[13] Grailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P, Faiz O. Laparoscopic versus open colorectal resection in the elderly population. SURG ENDOSC 2013; 27: 19-30.
[14] Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. DIS COLON RECTUM 2008; 51: 296-300.
[15] Sylla P, Kirman I, Whelan RL. Immunological advantages of advanced laparoscopy. Surg Clin North Am 2005; 85: 1-18.
[16] Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, Mills S. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. AM J SURG 2012; 204: 952-957.
[17] Orcutt ST, Marshall CL, Robinson CN, Balentine CJ, Anaya DA, Artinyan A, Awad SS, Berger DH, Albo D. Minimally invasive surgery in colon cancer patients leads to improved short-term outcomes and excellent oncologic results. AM J SURG 2011; 202: 528-531.
[18] Lian L, Kalady M, Geisler D, Kiran RP. Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians. SURG ENDOSC 2010; 24: 2039-2043.
[19] Pinto RA, Ruiz D, Edden Y, Weiss EG, Nogueras JJ, Wexner SD. How reliable is laparoscopic colorectal surgery compared with laparotomy for octogenarians? SURG ENDOSC 2011; 25: 2692-2698.
[20] Feng B, Zheng MH, Mao ZH, Li JW, Lu AG, Wang ML, Hu WG, Dong F, Hu YY, Zang L, Li HW. Clinical advantages of laparoscopic colorectal cancer surgery in the elderly. AGING CLIN EXP RES 2006; 18: 191-195.
[21] Vignali A, Di Palo S, Tamburini A, Radaelli G, Orsenigo E, Staudacher C. Laparoscopic vs. open colectomies in octogenarians: a case-matched control study. DIS COLON RECTUM 2005; 48: 2070-2075.
[22] Delgado S, Lacy AM, Garcia VJ, Balague C, Pera M, Salvador L, Momblan D, Visa J. Could age be an indication for laparoscopic colectomy in colorectal cancer? SURG ENDOSC 2000; 14: 22-26.
[23] Kapritsou M, Korkolis DP, Konstantinou EA. Open or laparoscopic surgery for colorectal cancer: a retrospective comparative study. GASTROENTEROL NURS 2013; 36: 37-41.
[24] Issa N, Grassi C, Melki Y, Powsner E, Dreznik Z. Laparoscopic colectomy for carcinoma of the colon in octogenarians. J GASTROINTEST SURG 2011; 15: 2011-2015.
[25] Bilimoria KY, Bentrem DJ, Merkow RP, Nelson H, Wang E, Ko CY, Soper NJ. Laparoscopic-assisted vs. open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. J GASTROINTEST SURG 2008; 12: 2001-2009.
[26] Nakamura T, Onozato W, Mitomi H, Naito M, Sato T, Ozawa H, Hatate K, Ihara A, Watanabe M. Retrospective, matched case-control study comparing the oncologic outcomes between laparoscopic surgery and open surgery in patients with right-sided colon cancer. SURG TODAY 2009; 39: 1040-1045.
[27] Sklow B, Read T, Birnbaum E, Fry R, Fleshman J. Age and type of procedure influence the choice of patients for laparoscopic colectomy. SURG ENDOSC 2003; 17: 923-929.
[28] Law WL, Lee YM, Choi HK, Seto CL, Ho JW. Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. DIS COLON RECTUM 2006; 49: 1108-1115.
[29] Barlehner E, Benhidjeb T, Anders S, Schicke B. Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. SURG ENDOSC 2005; 19: 757-766.
Cite This Article
  • APA Style

    Zexian Chen, Xiaosheng He, Juanni Huang, Xiaojian Wu, Ping Lan. (2016). Laparoscopic Versus Open Surgery for Rectal Cancer in Elderly Patients. Journal of Surgery, 4(2), 27-30. https://doi.org/10.11648/j.js.20160402.15

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    ACS Style

    Zexian Chen; Xiaosheng He; Juanni Huang; Xiaojian Wu; Ping Lan. Laparoscopic Versus Open Surgery for Rectal Cancer in Elderly Patients. J. Surg. 2016, 4(2), 27-30. doi: 10.11648/j.js.20160402.15

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    AMA Style

    Zexian Chen, Xiaosheng He, Juanni Huang, Xiaojian Wu, Ping Lan. Laparoscopic Versus Open Surgery for Rectal Cancer in Elderly Patients. J Surg. 2016;4(2):27-30. doi: 10.11648/j.js.20160402.15

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  • @article{10.11648/j.js.20160402.15,
      author = {Zexian Chen and Xiaosheng He and Juanni Huang and Xiaojian Wu and Ping Lan},
      title = {Laparoscopic Versus Open Surgery for Rectal Cancer in Elderly Patients},
      journal = {Journal of Surgery},
      volume = {4},
      number = {2},
      pages = {27-30},
      doi = {10.11648/j.js.20160402.15},
      url = {https://doi.org/10.11648/j.js.20160402.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20160402.15},
      abstract = {With the increase of life expectancy, surgical intervention for rectal cancer is more and more frequently performed in the elderly. It is well accepted that laparoscopic surgery is of advantage, but not widely recognized in old patients with rectal cancer. In order to assess laparoscopic surgery for rectal cancer in elderly patients, we performed this study. This retrospective study was designed to compare short-term outcomes between laparoscopic surgery and open surgery in elderly patients with rectal cancer, which may give some useful guidance in the clinical practice. Thirty-seven patients with rectal cancer aged 75 and older undergoing laparoscopic surgery were matched with 37 counterparts undergoing open surgery. Criteria of matching included general information and preoperative status. Patients in the laparoscopic surgery and open surgery groups were comparable for the matching criteria. Compared with the open surgery group, estimated blood loss (P=0.048) and intraoperative transfusion (P=0.042) were less in the laparoscopic surgery group. As to short-term postoperative outcomes, duration of postoperative hospital stay was shorter (P = 0.039) and overall complication (P = 0.032) and wound complication (P = 0.038) was less in the laparoscopic surgery group than in the open surgery group. In conclusion, considering the operative variables and short-term outcomes, laparoscopic surgery is safe and seems superior to open surgery in elderly patients with rectal cancer. However, further studies with more patients are needed to confirm the results and assess long-term results.},
     year = {2016}
    }
    

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  • TY  - JOUR
    T1  - Laparoscopic Versus Open Surgery for Rectal Cancer in Elderly Patients
    AU  - Zexian Chen
    AU  - Xiaosheng He
    AU  - Juanni Huang
    AU  - Xiaojian Wu
    AU  - Ping Lan
    Y1  - 2016/04/09
    PY  - 2016
    N1  - https://doi.org/10.11648/j.js.20160402.15
    DO  - 10.11648/j.js.20160402.15
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 27
    EP  - 30
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20160402.15
    AB  - With the increase of life expectancy, surgical intervention for rectal cancer is more and more frequently performed in the elderly. It is well accepted that laparoscopic surgery is of advantage, but not widely recognized in old patients with rectal cancer. In order to assess laparoscopic surgery for rectal cancer in elderly patients, we performed this study. This retrospective study was designed to compare short-term outcomes between laparoscopic surgery and open surgery in elderly patients with rectal cancer, which may give some useful guidance in the clinical practice. Thirty-seven patients with rectal cancer aged 75 and older undergoing laparoscopic surgery were matched with 37 counterparts undergoing open surgery. Criteria of matching included general information and preoperative status. Patients in the laparoscopic surgery and open surgery groups were comparable for the matching criteria. Compared with the open surgery group, estimated blood loss (P=0.048) and intraoperative transfusion (P=0.042) were less in the laparoscopic surgery group. As to short-term postoperative outcomes, duration of postoperative hospital stay was shorter (P = 0.039) and overall complication (P = 0.032) and wound complication (P = 0.038) was less in the laparoscopic surgery group than in the open surgery group. In conclusion, considering the operative variables and short-term outcomes, laparoscopic surgery is safe and seems superior to open surgery in elderly patients with rectal cancer. However, further studies with more patients are needed to confirm the results and assess long-term results.
    VL  - 4
    IS  - 2
    ER  - 

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Author Information
  • Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

  • Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

  • Department of Geriatric, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China

  • Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

  • Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

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