Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case-control study in Japan.
BACKGROUND
It remains controversial whether open or laparoscopic surgery should be indicated for elderly patients with colorectal cancer and a poor performance status.


METHODS
In those patients aged 80 years or older with Eastern Cooperative Oncology Group performance status score of 2 or greater who received elective surgery for stage 0 to stage III colorectal adenocarcinoma and had no concomitant malignancies and who were enrolled in a multicenter case-control study entitled "Retrospective study of laparoscopic colorectal surgery for elderly patients" that was conducted in Japan between 2003 and 2007, background characteristics and short-term and long-term outcomes for open surgery and laparoscopic surgery were compared.


RESULTS
Of the 398 patients included, 295 underwent open surgery and 103 underwent laparoscopic surgery. There were no significant differences in the baseline characteristics between open surgery and laparoscopic surgery patients, except for previous abdominal surgery and TNM stage. The median operation duration was shorter with open surgery (open surgery, 153 min; laparoscopic surgery, 202 min; P < 0.001), and less blood loss occurred with laparoscopic surgery (median open surgery, 109 g; median laparoscopic surgery, 30 g; P < 0.001). An operation duration of 180 min or more (odds ratio, 1.97; 95 % confidence interval, 1.17-3.37; P = 0.011) and selection of laparoscopic surgery (odds ratio, 0.41; 95 % confidence interval, 0.22-0.75; P = 0.003) were statistically significant in the multivariate analysis for postoperative morbidity. Moreover, laparoscopic surgery did not result in an inferior overall survival rate compared with open surgery (log-rank test P = 0.289, 0.278, 0.346, 0.199, for all-stage, stage 0-I, stage II, and stage III disease, respectively).


CONCLUSIONS
Laparoscopic surgery in elderly colorectal cancer patients with a poor performance status is safe and not inferior to open surgery in terms of overall survival.
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan. hiroaki_niitsu@yahoo.co.jp.
Hiroaki
H
Niitsu
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan. thinoi@hiroshima-u.ac.jp.
Takao
T
Hinoi
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
Yasuo
Y
Kawaguchi
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
Hideki
H
Ohdan
Department of Surgery, Keio University, Tokyo, Japan.
Hirotoshi
H
Hasegawa
Department of Gastrointestinal and General Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan.|Department of Surgery, Ako Central Hospital, Hyogo, Japan.
Ichio
I
Suzuka
Department of Surgery, Cancer Institute Hospital, Tokyo, Japan.
Yosuke
Y
Fukunaga
Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Takashi
T
Yamaguchi
Digestive Disease Center, Northern Yokohama Hospital, Showa University, Yokohama, Japan.|Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.
Shungo
S
Endo
Department of Surgery, Nagano Municipal Hospital, Nagano, Japan.|Department of Surgery, Shohnan Tobu General Hospital, Kanagawa, Japan.
Soichi
S
Tagami
Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan.|Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Hitoshi
H
Idani
Department of Surgery, Nishinomiya Municipal Central Hospital, Hyogo, Japan.|Digestive Disease Center, Amagasaki Chuo Hospital, Hyogo, Japan.
Takao
T
Ichihara
Department of Gastroenterological Surgery, Yokohama City University Medical Center, Kanagawa, Japan.|NTT Medical Center Tokyo, Tokyo, Japan.
Kazuteru
K
Watanabe
Department of Surgery, Kitasato University, Sagamihara, Japan.
Masahiko
M
Watanabe
D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
Colon cancer; Elderly patient; Laparoscopic surgery; Performance status; Rectal cancer