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

Colorectal Cancer
08/10/2020

Int J Colorectal Dis. 2020 Oct 7. doi: 10.1007/s00384-020-03770-0. Online ahead of print.

ABSTRACT

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.