Laparoscopic versus open surgery for elderly patients with colorectal cancer: a systematic review and meta‐analysis of matched studies

• Published in: ANZ journal of surgery Vol. 92; no. 9; pp. 2003 - 2017
• Main Authors: Luo, Weimin, Wu, Mengyuan, Chen, Yanling
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.09.2022; Blackwell Publishing Ltd
• Subjects: Aged; Cancer; Clinical trials; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - complications; Colorectal Neoplasms - surgery; Complications; Disease-Free Survival; elderly; Humans; laparoscopic surgery; Laparoscopy; Laparoscopy - adverse effects; Length of Stay; Meta-analysis; Older people; open surgery; Operative Time; Patients; Postoperative Complications - etiology; Risk; Statistical analysis; Surgery; Survival; Treatment Outcome; meta-analysis; open surgery; colorectal cancer; elderly; laparoscopic surgery
• ISSN: 1445-1433; 1445-2197; 1445-2197
• DOI: 10.1111/ans.17972

Background To compare clinical and survival outcomes between laparoscopic versus open surgery in elderly colorectal cancer patients. Methods PubMed, Embase and Scopus databases were systematically searched. The review included studies that were either randomized controlled trials (RCTs) or observational in design. STATA was used for statistical analysis. Results The meta‐analysis was conducted with 24 studies. Compared with elderly subjects with open surgery, those undergoing laparoscopic surgery had a lower risk of mortality (within 3 months postoperatively) (RR 0.70, 95% CI: 0.53, 0.94). The long‐term overall survival (HR 0.96, 95% CI: 0.89, 1.04), disease‐free survival (HR 1.02, 95% CI: 0.93, 1.13), risk of recurrence (RR 1.44, 95% CI: 0.90, 2.30) and readmission (RR 1.11, 95% CI: 0.88, 1.40) rates were statistically similar in both the groups. The operative time (in minutes) was higher (WMD 30.37, 95% CI: 17.75, 43.0) and the blood loss (in ml) was lower (WMD −78.85, 95% CI: −101.96, −55.75) in those undergoing laparoscopic surgery. The length of hospital stay (in days) (WMD −2.53, 95% CI: −3.11, −1.95) and the time of return of bowel movements (in days) (WMD −1.06, 95% CI: −1.20, −0.93) was lower in those with laparoscopic surgery. The pooled risk of complications was lower in those with laparoscopic surgery (RR 0.66, 95% CI: 0.60, 0.74), compared with open surgery. Conclusions Findings suggest that in elderly subjects with colorectal cancer, laparoscopic surgery appears to be more beneficial than open surgery and should be prioritized, subject to the availability of required technical skills and facilities. To compare clinical and survival outcomes between laparoscopic versus open surgery in elderly colorectal cancer patients. Findings suggest that in elderly subjects with colorectal cancer, laparoscopic surgery appears to be more beneficial than open surgery and should be prioritized, subject to availability of required technical skills and facilities.