title: Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients.
abstract: OBJECTIVE
  To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients.
  
  
  METHODS
  A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared laparoscopic colectomy (LAC) in elderly colorectal cancer patients with open colectomy (OC) were retrieved, and their short and long-term outcomes compared. Elderly people were defined as 65 years old or more. Inclusion criteria were set at: Resection of colorectal cancer, comparison between laparoscopic and OC and no significant difference in backgrounds between groups.
  
  
  RESULTS
  Fifteen studies were identified for analysis. LAC was performed on 1436 patients, and OC performed on 1810 patients. In analyses of short-term outcomes, operation time for LAC was longer than for OC (mean difference = 34.4162, 95%CI: 17.8473-50.9851, P < 0.0001). The following clinical parameters were lower in LAC than in OC: Amount of estimated blood loss (mean difference = -93.3738, 95%CI: -132.3437 to -54.4039, P < 0.0001), overall morbidity (OR = 0.5427, 95%CI: 0.4425-0.6655, P < 0.0001), incisional surgical site infection (OR = 0.6262, 95%CI: 0.4310-0.9097, P = 0.0140), bowel obstruction and ileus (OR = 0.6248, 95%CI: 0.4519-0.8638, P = 0.0044) and cardiovascular complications (OR = 0.4767, 95%CI: 0.2805-0.8101, P = 0.0062). In analyses of long-term outcomes (median follow-up period: 36.4 mo in LAC, 34.3 mo in OC), there was no significant difference in overall survival (mean difference = 0.8321, 95%CI: 0.5331-1.2990, P = 0.4187) and disease specific survival (mean difference = 1.0254, 95%CI: 0.6707-1.5675, P = 0.9209). There was also no significant difference in the number of dissected lymph nodes (mean difference = -0.1360, 95%CI: -4.0553-3.7833, P = 0.9458).
  
  
  CONCLUSIONS
  LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC were similar to that of OC. These results support the assertion that LAC is an effective procedure for elderly patients with colorectal cancer.
authors: Shoichi Fujii, Mitsuo Tsukamoto, Yoshihisa Fukushima, Ryu Shimada, Koichi Okamoto, Takeshi Tsuchiya, Keijiro Nozawa, Keiji Matsuda, Yojiro Hashiguchi, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
authors: Shoichi
authors: S
authors: Fujii
authors: Shoichi Fujii, Mitsuo Tsukamoto, Yoshihisa Fukushima, Ryu Shimada, Koichi Okamoto, Takeshi Tsuchiya, Keijiro Nozawa, Keiji Matsuda, Yojiro Hashiguchi, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
authors: Mitsuo
authors: M
authors: Tsukamoto
authors: Shoichi Fujii, Mitsuo Tsukamoto, Yoshihisa Fukushima, Ryu Shimada, Koichi Okamoto, Takeshi Tsuchiya, Keijiro Nozawa, Keiji Matsuda, Yojiro Hashiguchi, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
authors: Yoshihisa
authors: Y
authors: Fukushima
authors: Shoichi Fujii, Mitsuo Tsukamoto, Yoshihisa Fukushima, Ryu Shimada, Koichi Okamoto, Takeshi Tsuchiya, Keijiro Nozawa, Keiji Matsuda, Yojiro Hashiguchi, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
authors: Ryu
authors: R
authors: Shimada
authors: Shoichi Fujii, Mitsuo Tsukamoto, Yoshihisa Fukushima, Ryu Shimada, Koichi Okamoto, Takeshi Tsuchiya, Keijiro Nozawa, Keiji Matsuda, Yojiro Hashiguchi, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
authors: Koichi
authors: K
authors: Okamoto
authors: Shoichi Fujii, Mitsuo Tsukamoto, Yoshihisa Fukushima, Ryu Shimada, Koichi Okamoto, Takeshi Tsuchiya, Keijiro Nozawa, Keiji Matsuda, Yojiro Hashiguchi, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
authors: Takeshi
authors: T
authors: Tsuchiya
authors: Shoichi Fujii, Mitsuo Tsukamoto, Yoshihisa Fukushima, Ryu Shimada, Koichi Okamoto, Takeshi Tsuchiya, Keijiro Nozawa, Keiji Matsuda, Yojiro Hashiguchi, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
authors: Keijiro
authors: K
authors: Nozawa
authors: Shoichi Fujii, Mitsuo Tsukamoto, Yoshihisa Fukushima, Ryu Shimada, Koichi Okamoto, Takeshi Tsuchiya, Keijiro Nozawa, Keiji Matsuda, Yojiro Hashiguchi, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
authors: Keiji
authors: K
authors: Matsuda
authors: Shoichi Fujii, Mitsuo Tsukamoto, Yoshihisa Fukushima, Ryu Shimada, Koichi Okamoto, Takeshi Tsuchiya, Keijiro Nozawa, Keiji Matsuda, Yojiro Hashiguchi, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
authors: Yojiro
authors: Y
authors: Hashiguchi
keywords: Colorectal cancer; Elderly patient; Laparoscopic surgery; Meta-analysis; Systematic review