title: Effects of laparoscopic surgery on the patterns of death in elderly colorectal cancer patients: competing risk analysis compared with open surgery.
abstract: OBJECTIVE
  The effects of laparoscopic colorectal surgery (LAC) on the long-term outcomes of elderly patients remain unclear. This study aimed to assess the short- and long-term outcomes of LAC in elderly colorectal cancer patients and to quantify the effects of LAC on the patient death patterns.
  
  
  METHODS
  The clinicopathological data of elderly colorectal cancer patients aged ≥80 years old who were treated between 2006 and 2014 were extracted. The relationships between the clinicopathological factors and overall survival (OS) were assessed using the Cox proportional hazards model and Kaplan-Meier analyses. The risk factors for the types of death were estimated using a competing risk analysis.
  
  
  RESULTS
  A total of 107 patients were included. Fifty-two patients underwent LAC, whereas 55 underwent open surgery (OC). There were no significant differences in the American Society of Anesthesiologists grade or comorbidity rate between the groups. The postoperative complication rate was significantly lower with LAC than OC (p < 0.001). After adjustment for covariates, laparoscopic surgery was not a significant risk factor for any of the types of death.
  
  
  CONCLUSIONS
  LAC is an effective and safe technique for elderly patients with colorectal cancer. Furthermore, there was no significant association between the surgical procedure and the pattern of death.
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan. ohlkoh@gmail.com.|Department of Surgery, Keio University School of Medicine, Minato, Japan. ohlkoh@gmail.com.
authors.forename: Kohei
authors.initials: K
authors.lastname: Shigeta
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamafuji
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Asami
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takeshima
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Nagasaki
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Okamoto
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murata
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Arai
authors.affiliation: Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 330-8582, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kubochi
authors.affiliation: Department of Surgery, Keio University School of Medicine, Minato, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000401:mortality*; D008297:Male; D012044:Regression Analysis; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: Colorectal cancer; Elderly patient; Laparoscopic surgery; Pattern of death