Effects of minimal invasive surgery in elderly colorectal cancer patients

Abstract

Objective. Colorectal cancer (CRC) is a common disease. Among CRC patients, old aged patients are more likely to suffer from comorbidity than younger patients which increases concern whether to take surgery. However, in recent years, surgical skills have been rapidly evolved and indication of minimal invasive surgery has been increased. Nevertheless, still it has not been clearly established to apply these minimal invasive techniques to elderly CRC patients. This study aimed to compare postoperative and oncologic outcomes between minimal invasive surgery (MIS), including laparoscopic surgery and robotic surgery and open conventional surgery (OCS) in elderly CRC patient age 75 years and over.Materials and Methods. We retrospectively obtained data of CRC patients who underwent surgery between January 2005 and December 2011 in Gangnam Severance hospital, whose age was 75 years and over. Among 182 patients, 111 patients were diagnosed as colon cancer and 71 patients were diagnosed as rectal cancer, defined as less than 15cm from anal verge. Patients were divided as OCS group and MIS group according to surgical procedure within both cancer groups and analyzed. Patient’s characteristics and surgical outcomes, overall survival and disease free survival were evaluated.Results. There were no statistical differences in sex, age, body mass index, American Society of Anesthesiologists (ASA) class between OCS and MIS group in colon cancer and rectal cancer. Tumor histologic grade and type of operation were significant statistical different factors between OCS and MIS group in colon cancer. (p=0.044, p=0.006) Postoperative recovery showed time to first flatus (p=0.009, p=0.01), time to start diet (p<0.001, p<0.001), length of hospital stay (p<0.001, p=0.003) as a significant different factors between OCS and MIS group in both colon cancer and rectal cancer. There were no statistical difference with overall survival and disease free survival between OCS and MIS group in both colon cancer (p=0.861, p=0.972) and rectal cancer. (p=0.739, p=0.277)Conclusion. MIS in colorectal cancer surgery could be applied to elderly patients aged over 75 with acceptable morbidity and long-term oncologic outcomes compared to OCS.