[Comparison of the overall stress during large bowel operations in senior patients (laparoscopy versus open surgery)].
BACKGROUND
Colorectal surgery particularly as a treatment option for colorectal cancer comprises considerable and ever expanding spectrum of surgical procedures. Seniors (over 65 years of age) form the majority of patients operated for benign or malignant colon disease. High age in general poses one of the significant risks of the operation. The study analyses overall stress caused to patients by laparoscopy and laparotomy surgical procedures.


METHODS
Literature analysis of surgical stress in patients and prospective study of our patients' data collected over the period of four years. Comparable indicators: objectification of pre-operative stress and risks, per-operative cardiac and circulatory parameters, course of the lesion healing process, laboratory reactions of acute phase proteins, morbidity and lethality related to the surgery treatment.


RESULTS
Comparable results of tissue response examinations demonstrated no fundamental difference between laparoscopic and laparotomic operations performed on otherwise healthy younger individuals. Laparoscopic surgery, however, appears to be fully appropriate treatment modality in majority of patients suffering from colorectal disease, even in senior age. In advanced or complicated stages of the disease the open-section surgery still remains more efficient.


CONCLUSIONS
Age itself cannot be generally denoted as a fundamental risk factor. Co-morbid conditions, however, represent considerable risk, especially in high age patients. Laparoscopic surgery may well be applied even in senior age patients with no contra-indications. Yet, its application requires perfectly mastered laparoscopic technique and rational approach. Success of the operation in high-risk patients depends on close interdisciplinary cooperation, especially with anaesthetists.
Univerzita Karlova v Praze, 1. lékarská fakulta, I. chirurgická klinika VFN, Praha. robert.hvizd@vfn.cz
Robert
R
Hvizd'
Zdenek
Z
Krska
Jan
J
Kvasnicka
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007813:Laparotomy / Q000009:adverse effects; D011183:Postoperative Complications