Is laparoscopic colorectal surgery safe also in elderly patients?
Authors:
M. Kasalický 1,2; L. Martínek 3
; I. Penka 4
Authors place of work:
Chirurgická klinika 2. LF Univerzity Karlovy a ÚVN, Praha
1; Fakulta zdravotníctva a sociálnej práce, Trnavská univerzita
2; Chirurgická klinika 2. LF Univerzity Karlovy a FN v Motole
3; Chirurgická klinika FN Ostrava
4
Published in the journal:
Rozhl. Chir., 2018, roč. 97, č. 1, s. 21-26.
Category:
Original articles
Summary
Introduction:
Aging is a lifelong irreversible biological process. At the end of 2016, almost two million residents older than 65 years lived in the Czech Republic (18.8% of the population). Today, surgery in patients over 80 years of age is no exception. The laparoscopic approach in colorectal surgery could bring benefits also in a reasonably selected group of geriatric patients. The aim of this study was to find out whether laparoscopic colorectal surgery is safe in elderly patients.
Method:
A retrospective analysis was performed of 1175 medical records of patients undergoing elective colon or rectal resection from 2010 to 2016 using the laparoscopic or open technique. The monitored data included characteristics of the patients, surgical diagnostic data, data related to the procedure and evaluation of the postoperative period including any complications. Clavien-Dindo classification was used to assess the severity of postoperative complications. The postoperative complications were analyzed in relation to the age (<75 years, ≥75 years) and operative technique (laparoscopic, open).
Results:
The duration of surgery was significantly longer in the laparoscopic group aged 75 years or older. The postoperative complications rate, morbidity and mortality increased in the open group with age. A statistically significant difference was observed in morbidity in the open technique group (44% vs 34%, p=0.046), without any significant difference in mortality. In the laparoscopic group, there was no significant difference in morbidity (36% vs 32%, not significant) and letality copied the situation observed in laparotomic procedures. The lower incidence of postoperative complications in laparoscopic procedures, particularly in patients over 75 years of age, was reflected in a significant shortening of the length of hospital stay. A significantly lower incidence of less serious postoperative complications (Clavien-Dindo I-II) was confirmed in the laparoscopic group in elderly patients.
Conclusion:
Among others, ageing is associated with an increasing number of elderly patients with colorectal diseases, especially with colorectal cancer or complicated diverticular disease. As follows from this article, the laparoscopic approach in colorectal surgery is as safe and effective as the laparotomic (open) approach. Moreover, laparoscopic surgery is associated with reduced pain, faster recovery of activity of the gastrointestinal tract, more rapid recovery and thus a reduced risk of some postoperative complications such as early infections.
Key words:
ageing − geriatric patient − laparoscopy − colorectal surgery
Zdroje
1. Český statistický úřad. Senioři. (cit. 2016-11-04). Available from: https://www.czso.cz/csu/czso/statistiky.
2. Ondrušová J. Stáří a smysl života. 1vydání. Praha, Karolinum 2011.
3. Zavazalová H. Vybrané kapitoly ze sociální gerontologie. 1. vydání. Praha, Karolinum 2001.
4. Sýkorová D. Autonomie ve stáří: kapitoly z gerontosociologie. 1. vydání. Praha, Sociologické nakladatelství 2007:62−5.
5. Český statistický úřad. Senioři [online]. (cit. 2016-11-04).
6. ČESKÝ STATISTIKÝ ÚŘAD. Available from: https://www.czso.cz/csu/czso/ceska-republika-od-roku-1989-v- cislech-w0i9dxmghn#01.
7. Korzenik JR. NDSG Diverticulitis: new frontiers for an old country: risk factors and pathogenesis. J Clin Gastroenterol 2008;42:1128–9.
8. Rasool S, Kadla SA, Rasool V, et al. A comparative overview of general risk factors associated with the incidence of colorectal cancer. Tumour Biol 2013;34:2469–76.
9. Antoniou AS, Antoniou GA, Koch OO, et al. Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66 483 patients. Surg Endosc 2015;29:322−33.
10. Spiezia S, Grassia S, De Rosa D, et al. Laparoscopic cholecystectomy in the elderly. BMC Geriatrics 2011; 11(Suppl 1): A59.
11. Oor JE, Koetje HJ, Roks DJ, et al. Laparoscopic hiatal hernia repair in the elderly patient. World J Surg 2016;40:1404–11.
12. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991; 1:144–50.
13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Amm Surg 2004;240:205−13.
14. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. In: Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, et al. Lancet Oncol 2009;10:44–52.
15. Van der Pas MH, Haglind E, Cuesta MA, et al. Colorectal Cancer Laparoscopic or Open Resection II (COLOR II) Study Group Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomized, phase 3 trial. Lancet Oncol 2013;14:210−18.
16. Bonjer HJ, Deijen CL, Abis GA, et al. COLOR II Study Group. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 2015;372:1324–32.
17. Grailey K, Markar SR, Karthikesalingam A, et al. Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc 2013;27:19−30.
18. Kalvach Z, Mikeš Z. Základní pojmy − stáří, geriatrie a gerontologie. In Kalvach Z, Zadák Z, Jirák J, et al. Geriatrie a gerontologie. Praha, Grada 2004:47−50.
19. Kasalický M. In Šváb a kol. Chirurgie vyššího věku. Praha, Grada 2008:25−7.
20. Wolters U, Wolf T, Stützer H, et al. ASA classification and perioperative variables as predictors of postoperative outcome. British Journal of Anesthesia 1996;77:217−22.
21. Nishikawa T, Ishihara S, Hata K, et al. Short-term outcomes of open versus laparoscopic surgery in elderly patients with colorectal cancer. Surg Endosc 2016;30:5550−7.
22. Kostrouch D, Martinek L, Hoch J. Kolorektální karcinom u seniorů − děláme to dobře? Rozhl Chir 2017;96:197−201
Štítky
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