Evaluation of short- and long-term outcomes following laparoscopic surgery for colorectal cancer in elderly patients aged over 80 years old: a propensity score-matched analysis

• Published in: International journal of colorectal disease Vol. 36; no. 2; pp. 365 - 375
• Main Authors: Sueda, Toshinori, Tei, Mitsuyoshi, Nishida, Kentaro, Yoshikawa, Yukihiro, Matsumura, Tae, Koga, Chikato, Wakasugi, Masaki, Miyagaki, Hiromichi, Kawabata, Ryohei, Tsujie, Masanori, Hasegawa, Junichi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2021; Springer; Springer Nature B.V
• Subjects: Age; Aged patients; Analysis; Cancer; Cancer patients; Colorectal cancer; Colorectal carcinoma; Gastroenterology; Hepatology; Internal Medicine; Laparoscopic surgery; Laparoscopy; Lymph nodes; Medicine; Medicine & Public Health; Multivariate analysis; Original Article; Patient outcomes; Proctology; Risk factors; Surgery; Survival; Target marketing; Propensity score matching; Laparoscopic surgery; Oncological outcomes; Elderly; Colorectal cancer
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-020-03770-0

Purpose It remains controversial whether the advantages of laparoscopic surgery for colorectal cancer (CRC) are beneficial in elderly patients (EP, age ≥ 80 years). The present study aimed to evaluate whether age itself is an independent risk factor for laparoscopic surgery by comparing short- and long-term outcomes between non-EP and EP groups. Methods We retrospectively analyzed 730 consecutive patients with stage I–III CRC who had undergone elective surgery between 2010 and 2017, using propensity score–matched analysis. Results Median follow-up was 49 months. After matching, we enrolled 228 patients. In the matched cohort, estimated operative time, estimated blood loss, lymph node dissection ≥ D3, number of lymph nodes harvested < 12, conversion rate, multivisceral resection rate, postoperative complication rate, and length of postsurgical stay were similar between the two groups. Before matching, compared with the non-EP group, the EP group had significantly shorter overall survival (OS) ( p  < 0.01), cancer-specific survival (CSS) ( p  < 0.01), recurrence-free survival (RFS) ( p  < 0.01), and higher frequency of local recurrence (LR) ( p  = 0.01); however, there was no significant difference in terms of incidence of LR or CSS between the two groups in the matched cohort. Prior to matching, multivariate analysis identified age ≥ 80 years as an independent prognostic factor for OS ( p  < 0.01), CSS ( p  < 0.01), and RFS ( p  = 0.01); however, after matching, age ≥ 80 years was not an independent poor prognostic factor for OS or CCS. Conclusions Laparoscopic surgery offers a safe, effective option for CRC in EP aged ≥ 80 years.