title: Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients.
abstract: BACKGROUND
  Increasing life expectancy requires specific attention on geriatric patients. Data support a potential reduction of surgical morbidity for patients undergoing laparoscopic surgery as compared to conventional surgery. The aim of this study was to investigate the comparative effect of laparoscopic and open colorectal surgery on geriatric patients.
  
  
  METHODS
  A systematic review of electronic information sources was undertaken. Studies that provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open colorectal surgery, were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was independently appraised by two reviewers. Random effects model was applied to synthesize outcome data.
  
  
  RESULTS
  Twenty-seven articles providing data for 66,592 patients were included in the analysis. Patients undergoing laparoscopic surgery had a decreased risk for mortality (2.2 vs. 5.4 %; OR 0.55, 95 % CI 0.44-0.67), overall morbidity (19.3 vs. 26.7 %; OR 0.54, 95 % CI 0.46-0.63), cardiac (4.7 vs. 7.7 %; OR 0.60, 95 % CI 0.39-0.92) and respiratory complications (3.9 vs. 6.3 %; OR 0.67, 95 % CI 0.47-0.95). Sensitivity analysis including reports with similar age, American Society of Anesthesiologists score and/or similar prevalence of cardiopulmonary morbidity between the laparoscopic and the open treatment arm validated the outcome estimates of the primary analysis.
  
  
  CONCLUSIONS
  This analysis supports a substantial benefit for elderly patients undergoing laparoscopic in comparison with open colorectal surgery. The comparative effect of either approach on geriatric patients with pulmonary and cardiac comorbidities is a subject of further investigation.
authors.affiliation: Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany, stavros.antoniou@hotmail.com.
authors.forename: Stavros Athanasios
authors.initials: SA
authors.lastname: Antoniou
authors.forename: George Athanasios
authors.initials: GA
authors.lastname: Antoniou
authors.forename: Oliver Owen
authors.initials: OO
authors.lastname: Koch
authors.forename: Rudolph
authors.initials: R
authors.lastname: Pointner
authors.forename: Frank-Alexander
authors.initials: FA
authors.lastname: Granderath
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D009017:Morbidity; D012002:Rectal Diseases / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome