title: Laparoscopic versus open surgery for colorectal cancer in elderly patients: a multicenter matched case-control study.
abstract: BACKGROUND
  The safety of laparoscopic surgery (LAP) in elderly patients with colorectal cancer has not been demonstrated. The aim of this study was to compare the outcomes of LAP and open surgery (OP) and estimate the feasibility of LAP in colorectal cancer patients aged ≥ 80 years.
  
  
  METHODS
  We conducted a propensity scoring matched case-control study of colon and rectal cancer patients aged ≥ 80 years using data from 41 hospitals between 2003 and 2007. A total of 1,526 colon cancer patients and 282 rectal cancer patients underwent surgery and were included in the analysis. The primary end point was 3-year overall survival (OS). Secondary end points included disease-free survival (DFS), cancer-specific survival (CSS), and postoperative complications.
  
  
  RESULTS
  LAP and OP were compared in 804 colon cancer patients (402 pairs) and 114 rectal cancer patients (57 pairs) after all covariates were balanced, and no significant differences were observed, except for tumor size in colon cancer. OS, DFS, and CSS did not differ between the groups for either colon cancer (P = 0.916, 0.968, and 0.799, respectively) or rectal cancer (P = 0.765, 0.519, and 0.950, respectively). In colon cancer cases, LAP was associated with fewer morbidities than was OP (24.9 vs. 36.3 %, P < 0.001); no such difference was observed for rectal cancer patients (47.4 vs. 40.4 %, P = 0.450).
  
  
  CONCLUSIONS
  LAP is an acceptable alternative to OP in elderly patients with colorectal cancer.
authors.affiliation: Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan, thinoi@hiroshima-u.ac.jp.
authors.forename: Takao
authors.initials: T
authors.lastname: Hinoi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Minoru
authors.initials: M
authors.lastname: Hattori
authors.forename: Masazumi
authors.initials: M
authors.lastname: Okajima
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Hisanaga
authors.initials: H
authors.lastname: Horie
authors.forename: Kohei
authors.initials: K
authors.lastname: Murata
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000401:mortality*; D007902:Length of Stay; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors