title: Laparoscopy-assisted versus open colectomy for treatment of colon cancer in the elderly: morbidity and mortality outcomes in 545 patients.
abstract: BACKGROUND
  Advanced age is a risk factor of major abdominal surgery due to diminished functional reserve and increased comorbidity. Laparoscopy-assisted colectomy is a well-established procedure in colon cancer surgery. The aim of this study was to compare early outcome of elective laparoscopy surgery and open colectomy in colon cancer patients according to age.
  
  
  METHODS
  A total of 545 patients with colonic adenocarcinoma underwent elective surgery between 2005 and 2009. There were 277 patients in the laparoscopic group and 268 in the open. Patient characteristics in both groups were homogeneous and further stratified into three subgroups by age: <75, between 75-84, and ≥ 85 years. Main outcome measures were early morbidity, mortality, and hospital stay.
  
  
  RESULTS
  Open surgery group showed a higher overall morbidity rate (37.3 vs. 21.6%, P = 0.001), medical complications (16.4 vs. 10.5%, P = 0.033), surgical complications (23.5 vs. 15.5%, P = 0.034), and mortality (6.7 vs. 3.2%, P = 0.034). The overall morbidity rate difference between open and laparoscopy approach disappeared in the oldest group (≥ 85 years old). Surgical site infections rate was inferior for patients <75 years old in laparoscopy group compared with open. Mortality was also significantly inferior in laparoscopy group in younger patients (<75 years, 0 vs. 3%, P = 0.038). Mean hospital stay was shorter for patients in <75 and 75-84 groups with laparoscopic approach (7.8 vs. 11.4 days and 10 vs. 14.3, respectively, P = 0.001) as compared with those who underwent open surgery, but these differences disappeared in patients aged ≥ 85 years.
  
  
  CONCLUSIONS
  Laparoscopy-assisted colectomy in patients underwent elective surgical resections for colon cancer showed advantages in rate of early complications in patients younger than 85 years of age and was found to be as safe and well tolerated as open surgery in patients over 85 years of age.
authors.affiliation: Unit of Colorectal Surgery, General and Digestive Surgery Department, Hospital Universitario Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain, 20412fvv@comb.cat.
authors.forename: Francesc
authors.initials: F
authors.lastname: Vallribera Valls
authors.forename: Filippo
authors.initials: F
authors.lastname: Landi
authors.forename: Eloy
authors.initials: E
authors.lastname: Espín Basany
authors.forename: José Luis
authors.initials: JL
authors.lastname: Sánchez García
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Jiménez Gómez
authors.forename: Marc
authors.initials: M
authors.lastname: Martí Gallostra
authors.forename: Luis
authors.initials: L
authors.lastname: Salgado Cruz
authors.forename: Manuel
authors.initials: M
authors.lastname: Armengol Carrasco
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome