title: Influence of previous abdominal surgery on surgical outcomes between laparoscopic and open surgery in elderly patients with colorectal cancer: subanalysis of a large multicenter study in Japan.
abstract: BACKGROUND
  The aim of the present study was to examine the technical and oncological feasibility of laparoscopic surgery (LAP) in elderly patients with a history of abdominal surgery.
  
  
  METHODS
  We conducted a propensity score-matched case-control study of colorectal cancer (CRC) patients aged ≥80 years that were treated at 41 hospitals between 2003 and 2007. We included 601 patients who had a history of abdominal surgery and underwent curative and elective surgery for stage 0 to III CRC. After the matching procedure, 153 patients were included in each cohort. The surgical outcomes of LAP and open surgery (OS) were compared. P-values of <0.05 were considered statistically significant.
  
  
  RESULTS
  LAP resulted in a significantly longer surgical time (220 vs. 170 min, p < 0.001), but significantly less intraoperative blood loss (39 vs. 100 ml, p < 0.001). A number of postoperative recovery-related parameters, including the length of the hospitalization period (12 vs. 14 days, p = 0.002), and the days to the resumption of fluid (2 vs. 3 days, p < 0.001) and solid food intake (4 vs. 5 days, p < 0.001), were significantly better in the LAP group. Moreover, the overall morbidity rate (43 vs. 66 %, p = 0.009) and the frequency of postoperative ileus (7 vs. 19 %, p = 0.023) were significantly lower in the LAP group, while the frequencies of other morbidities did not differ significantly between the groups. In the survival analyses, overall survival and disease-free survival did not differ between the two groups.
  
  
  CONCLUSIONS
  In this population, LAP can be performed safely in elderly CRC patients with a history of abdominal surgery, and LAP resulted in a lower postoperative morbidity rate than OS.
authors.affiliation: Division of Gastrointestinal Surgery, Hiratsuka City Hospital, 19-1-1, Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan. miyamamo@jcom.home.ne.jp.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.|Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Hinoi
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Niitsu
authors.affiliation: Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Masazumi
authors.initials: M
authors.lastname: Okajima
authors.affiliation: Department of Surgery, Suita Municipal Hospital, Suita, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Ide
authors.affiliation: Department of Surgery, Suita Municipal Hospital, Suita, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Murata
authors.affiliation: Department of Gastroenterological Surgery, Kagawa University Hospital, Kagawa, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Akamoto
authors.affiliation: Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kanazawa
authors.affiliation: Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Naitoh
authors.affiliation: Department of Surgery, Ageo Central General Hospital, Ageo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kanehira
authors.affiliation: Department of Gastroenterological Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Shimamura
authors.affiliation: Department of Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
authors.forename: Ichio
authors.initials: I
authors.lastname: Suzuka
authors.affiliation: Department of Surgery, Cancer Institute Ariake Hospital, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Fukunaga
authors.affiliation: National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Surgery, Kitasato University Hospital, Sagamihara, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Complication; Elderly patients; Laparoscopic colorectal surgery; Matched case–control study; Previous abdominal surgery; Propensity scoring