Influence of previous abdominal surgery on surgical outcomes between laparoscopic and open surgery in elderly patients with colorectal cancer: subanalysis of a large multicenter study in Japan
AbstractBackgroundThe aim of the present study was to examine the technical and oncological feasibility of laparoscopic surgery (LAP) in elderly patients with a history of abdominal surgery.MethodsWe conducted a propensity score matched case control study of colorectal cancer (CRC) patients aged =80 years that were treated at 41 hospitals between 2003 and 2007. We included 601 patients who had a history of abdominal surgery and underwent curative and elective surgery for stage 0 to III CRC. After the matching procedure, 153 patients were included in each cohort. The surgical outcomes of LAP and open surgery (OS) were compared. P values of <0.05 were considered statistically significant.ResultsLAP resulted in a significantly longer surgical time (220 vs. 170 min, p 0.001) but significantly less intraoperative blood loss (39 vs. 100 ml, p 0.001) A number of postoperative recovery related parameters, including the length of the hospitalization period (12 vs. 14 days, p 0.002) and the days to the resumption of fluid (2 vs. 3 days, p 0.001) and solid food intake (4 vs. 5 days, p 0.001) were significantly better in the LAP group. Moreover, the overall morbidity rate (43 vs. 66 p 0.009) and the frequency of postoperative ileus (7 vs. 19 p 0.023) were significantly lower in the LAP group, while the frequencies of other morbidities did not differ significantly between the groups. In the survival analyses, overall survival and disease free survival did not differ between the two groups.ConclusionsIn this population, LAP can be performed safely in elderly CRC patients with a history of abdominal surgery, and LAP resulted in a lower postoperative morbidity rate than OS.
Journal of Gastroenterology