Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians

• Published in: Surgical endoscopy Vol. 24; no. 8; pp. 2039 - 2043
• Main Authors: Lian, Lei, Kalady, Matthew, Geisler, Daniel, Kiran, Ravi Pokala
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.08.2010; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged, 80 and over; Biological and medical sciences; Colectomy - methods; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology; Gynecology; Hepatology; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Length of Stay - statistics & numerical data; Male; Medical sciences; Medicine; Medicine & Public Health; Proctology; Prospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Laparoscopic colectomy; Octogenarian; Complications; Open colectomy; Elderly; Geriatrics; Human; Endoscopic surgery; Colectomy; Laparoscopy; Treatment; Complication; Endoscopy; Colon; Hospital
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-010-0900-x

Background Concerns about prolonged postoperative recovery may detract surgeons from offering colectomy to patients older than 80 years. The adoption of a minimally invasive approach may help to counter these beliefs, but concerns remain as to whether these patients can tolerate a pneumoperitoneum. This study compared outcomes after laparoscopic colectomy (LC) and open colectomy (OC) for patients older than 80 years. Methods From a prospectively maintained database, 97 patients undergoing elective LC between 1994 and 2008 were identified and matched 1:1 to OC patients for age, gender, year of surgery, extent of resection, proximal diversion, American Society of Anesthesiology score, and body mass index. Short-term outcomes including postoperative mortality, morbidity, and discharge status were assessed. Results The LC and OC patients were similar for the matched characteristics. Their mean age was 82.8 years (range, 80–94 years). The conversion rate for the LC patients was 14.4%. The OC group had a higher proportion of cancer patients (93.8% vs. 59.8%; P  = 0.001). The discharge status for the LC and OC patients was similar, and most patients were discharged home without assistance (63.9% vs. 62.9%; P  = 0.88). The median hospital stay was significantly shorter for LC (6 days; range, 1–67 days) than for OC (7 days; range, 2–53 days; P  = 0.001). The 30-day postoperative complications (OC, 43.3% vs. LC, 37.1%; P  = 0.38), reoperations (OC, 5.2% vs. LC, 4.1%; P  = 0.73), and readmissions (OC, 6.2% vs. LC, 9.3%; P  = 0.41) were similar. The overall mortality rate was 5.2% and similar between the two groups. Conclusion Complications and other outcomes are similar for LC and OC, and the earlier recovery associated with LC, as evidenced by a shorter hospital stay, may encourage a wider adoption of LC for patients older than 80 years.