Feasibility and outcomes of surgical therapy in very elderly patients with colorectal cancer.
OBJECTIVE
Short-term and midterm outcomes of surgery remain unclear in very elderly patients (≥85 y) with colorectal cancer. This study was designed to clarify the safety and therapeutic usefulness of surgery for colorectal cancer in this subgroup of patients. We compared postoperative short-term and midterm outcomes between laparoscopic surgery and open surgery to evaluate the feasibility of laparoscopic surgery in very elderly patients.


METHODS
The study group comprised 80 patients [38 men (48%) and 42 women (52%)] aged 85 years or older who had colorectal cancer and were treated in our department from 1987 to 2010. The mean age was 87.3±2.3 years, and the median follow-up was 45 months (range, 4 to 252 mo). Sixty-nine patients (86%) were 85 to 89 years old, and 11 (14%) were aged 90 years or older. The American Society of Anesthesiologists' (ASA) risk class was I in 2 patients (2%), II in 44 (55%), and III in 34 (43%). Open surgery was performed in 46 patients (58%), and laparoscopic surgery was performed in 34 patients (42%).


RESULTS
The ASA risk class was II or III in 78 patients (98%). Postoperative complications occurred in 21 patients (26%), including ileus in 8 patients (10%), wound infection in 7 (9%), and anastomotic leakage in 3 (4%). As compared with open surgery, laparoscopic surgery had significantly lower intraoperative blood loss (P<0.0001) and a significantly shorter postoperative hospital stay (P=0.0001) but required a significantly longer operation time (P=0.0017). Clinicopathologically, laparoscopic surgery was associated with a significantly smaller tumor size (P=0.0371), significantly fewer dissected lymph nodes (P=0.0181), and significantly fewer patients with stage II or III disease (P=0.0090). Postoperative complications occurred in 14 patients (30%) in the open surgery group and 6 (18%) in the laparoscopic surgery group, but this difference was not significant. As for midterm outcomes, the disease-free survival rate and the overall survival rate were, respectively, 90.9% and 100% in stage I disease, 89.7% and 100% in stage II disease, and 68.4% and 75.9% in stage III disease.


CONCLUSIONS
Colorectal surgery was safe, therapeutically useful, and had good short-term and midterm outcomes in very elderly patients with colorectal cancer. As compared with open surgery, laparoscopic surgery was associated with lower intraoperative blood loss and a shorter postoperative hospital stay. These results suggest that laparoscopic surgery is suitable for very elderly patients with colorectal cancer because it is less invasive than open surgery.
Department of Surgery, School of Medicine, Kitasato University, Kitasato, Kanagawa, Japan.
Takatoshi
T
Nakamura
Takeo
T
Sato
Hirohisa
H
Miura
Atushi
A
Ikeda
Atsuko
A
Tsutsui
Masanori
M
Naito
Naoto
N
Ogura
Masahiko
M
Watanabe
D000367:Age Factors; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome