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Ammirati CA, Passera R, Beltrami E, Peluso C, Francis N, Arezzo A. Laparoscopic and robotic surgery for colorectal cancer in older patients: a systematic review and meta-analysis. MINIM INVASIV THER 2024; 33:253-269. [PMID: 38946054 DOI: 10.1080/13645706.2024.2360094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/21/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION As life expectancy has been increasing, older patients are becoming more central to the healthcare system, leading to more intensive care use and longer hospital stays. Nevertheless, advancements in minimally invasive surgical techniques offer safe and effective options for older patients with colorectal diseases. This study aims to provide comprehensive evidence on the role of minimally invasive surgery in treating colorectal diseases in older patients. MATERIAL AND METHODS All articles directly compared the minimally invasive approach with open surgery in patients aged ≥65 years. The present metanalysis took 30-day complications as primary outcomes. Length of hospital stay, readmission, and 30-day mortality were also assessed, as secondary outcomes. Further subgroup analyses were carried out based on surgery setting, lesion features, and location. RESULTS After searching the main databases, 84 articles were included. Evaluation of 30-day complications rate, length of hospital stay, and 30-day mortality significantly favored minimally invasive approaches. The outcome readmission did not show any significant difference. CONCLUSIONS The current metanalysis demonstrates clear advantages of minimally invasive techniques over open surgery in colorectal procedures for older patients, particularly in reducing complications, mortality, and hospitalization. This suggests that prioritizing these techniques, based on available expertise and facilities, could improve outcomes and quality of care for older patients undergoing colorectal surgery.
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Affiliation(s)
| | - Roberto Passera
- Nuclear Medicine Division, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Elsa Beltrami
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Chiara Peluso
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Nader Francis
- Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, UK
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Torino, Italy
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Keller DS, Curtis N, Burt HA, Ammirati CA, Collings AT, Polk HC, Carrano FM, Antoniou SA, Hanna N, Piotet LM, Hill S, Cuijpers ACM, Tejedor P, Milone M, Andriopoulou E, Kontovounisios C, Leeds IL, Awad ZT, Barber MW, Al-Mansour M, Nassif G, West MA, Pryor AD, Carli F, Demartines N, Bouvy ND, Passera R, Arezzo A, Francis N. EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults. Surg Endosc 2024; 38:4104-4126. [PMID: 38942944 PMCID: PMC11289045 DOI: 10.1007/s00464-024-10977-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery. METHODS Expert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology. RESULT Older adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery. CONCLUSIONS MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.
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Affiliation(s)
- Deborah S Keller
- Department of Digestive Surgery, University of Strasbourg, Strasbourg, FR, USA
| | - Nathan Curtis
- Surgical Unit, Dorset County Hospital, Dorchester, Dorset, UK
| | | | | | - Amelia T Collings
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hiram C Polk
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Francesco Maria Carrano
- Department of General and Minimally Invasive Surgery, Busto Arsizio Circolo Hospital, ASST-Valle Olona, Varese, Italy
| | - Stavros A Antoniou
- Department of General Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nader Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Sarah Hill
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Anne C M Cuijpers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patricia Tejedor
- Department of Colorectal Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marco Milone
- Department of Clinical and Surgical Gastrointestinal Diseases, University of Naples "Federico II", Via Pansini 5, Naples, Italy
| | - Eleni Andriopoulou
- Department of Surgery, Hellenic Red Cross Korgialeneio Benakeio NHS, Athens, Greece
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Campus and the Royal Marsden Hospital, London, UK
| | - Ira L Leeds
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Meghan Wandtke Barber
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Mazen Al-Mansour
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - George Nassif
- Department of Colorectal Surgery, AdventHealth, Orlando, FL, USA
| | - Malcolm A West
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
- Complex Cancer and Exenterative Service, University Hospitals Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton, Southampton, UK
| | - Aurora D Pryor
- Long Island Jewish Medical Center and System Chief for Bariatric Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA
| | - Franco Carli
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | - Nicole D Bouvy
- Innovative Surgical Techniques, Endoscopic and Endocrine Surgery, Department of Surgery, Maastricht University Medical Center, Amsterdam, Netherlands
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Turin, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Nader Francis
- Department of Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK.
- The Griffin Institute, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK.
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Braschi C, Liu JK, Moazzez A, Petrie BA. Is laparoscopic surgery safe for elderly patients with diverticulitis? A national database study. Langenbecks Arch Surg 2022; 407:3599-3606. [PMID: 36149492 DOI: 10.1007/s00423-022-02695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/17/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Laparoscopy is the preferred approach to elective surgery for diverticulitis and is increasingly common in the emergent setting. Although diverticulitis is most prevalent among older adults, little is known about the safety of laparoscopy for elderly patients with diverticulitis. This study aims to compare 30-day outcomes of a laparoscopic versus open approach for diverticulitis among elderly patients undergoing elective and urgent/emergent surgery. METHODS Patients ≥ 65 years who underwent surgery for diverticulitis from 2015 to 2019 were identified from the ACS-NSQIP database. Elective and non-elective groups were analyzed separately. Coarsened exact matching matched laparoscopic and open patients 1:1 based on preoperative factors to minimize selection bias by creating comparable cohorts. Short-term outcomes of laparoscopic versus open surgery were compared. RESULTS A total of 15,316 patients were included, 69.2% female and 88% White, with a mean age of 72.7 ± 6.1 years. Approximately half (50.9%) of cases were laparoscopic and 60.6% were elective. After matching, laparoscopy was associated with lower 30-day morbidity in both the elective (OR, 0.47; 95%CI, 0.38-0.58) and non-elective (OR, 0.76; 95%CI, 0.58-0.98) cohorts. Laparoscopic surgery in both cohorts was associated with fewer surgical site infections (SSIs) (elective, OR 0.43; 95%CI, 0.33-0.57; non-elective, OR, 0.66; 95%CI, 0.44-0.98) and shorter length of stay (LOS) (elective, mean difference, 1.7 days; 95%CI, 1.5-1.9; non-elective, mean difference, 1.2 days; 95%CI, 0.43-2.1). CONCLUSION Elderly patients undergoing both elective and non-elective laparoscopic surgery for diverticulitis have less 30-day morbidity, SSIs, and shorter LOS compared to an open approach. Therefore, laparoscopy for elderly patients is safe in elective surgery and in select emergent cases as well.
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Affiliation(s)
- Caitlyn Braschi
- Division of Colon & Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jessica K Liu
- Division of Colon & Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ashkan Moazzez
- Division of General & Bariatric Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
| | - Beverley A Petrie
- Division of Colon & Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
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Franchini Melani AG, Capochin Romagnolo LG. Management of postoperative complications during laparoscopic anterior rectal resection. Minerva Surg 2021; 76:324-331. [PMID: 33944518 DOI: 10.23736/s2724-5691.21.08890-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laparoscopic anterior resection (LAR) is currently a routine practice in specialized high-volume centers, with equivalent oncological outcomes in historical, open surgery. Appropriate pelvic dissection can be measured by the adequacy of circumferential margin (CRM) and distal margin, both are risk factors of local recurrence. Among the various operative procedures for colorectal cancer, low anterior resection (LAR) for rectal cancer is one of the most demanding procedures because it requires resection of cancer with surrounding mesorectal tissue and reconstruction with anastomosis in the narrow pelvis while preserving the autonomic nerves of the urogenital organs particularly in the male pelvis. Low anterior resection is associated with a relatively high incidence of postoperative morbidities, including anastomotic leakage and other operative site infections, and asymptomatic patients infected with COVID-19 submitted to elective could be at higher risk which sometimes result in post operative mortality. Therefore, recognition of the incidence and risk factors of postoperative complications following low anterior resection is essential to prevent it. The importance of some risk factors such as age, nutrition status of the patient, experience of the surgeon and many other factors that influence outcome of colorectal surgery which could be modified pre operatively to prevent post operative complications. In the other hand long term post operative complications may promote tumor recurrence and decrease survival. The severity of these complications was evaluated by Clavien-Dindo classification (Table1) initiated in 1992 is based on the type of therapy needed to correct the complication. The principle of the classification is simple, reproducible, flexible, and applicable. The Clavien-Dindo Classification(1) appears reliable and may represent a compelling tool for quality assessment in surgery. Post-operative complications can also be classified according to time-line related to surgery as such, early postoperative complications can be defined where morbidity rates occurred within 30 days of the procedure (25%-32%)- (Table 2) or long-term as those that take place between the 30th post-operative day to 3 years following. The aims of this review are to provide an overview of the current literature on post operative complications of rectal surgery and to describe risk factors and strategies to prevent, treat or reduce complications.
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Affiliation(s)
- Armando G Franchini Melani
- Americas Medical City, Rio de Janeiro, Brazil - .,Departament of Surgery, IRCAD Latin America, Barretos, São Paulo, Brazil -
| | - Luis G Capochin Romagnolo
- Departament of Surgery, IRCAD Latin America, Barretos, São Paulo, Brazil.,Department of Colon and Rectal Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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The Trends in Adoption, Outcomes, and Costs of Laparoscopic Surgery for Colorectal Cancer in the Elderly Population. J Gastrointest Surg 2021; 25:766-774. [PMID: 32424686 DOI: 10.1007/s11605-020-04517-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The elderly constitute the majority of both colorectal cancer and surgical volume. Despite established safety and feasibility, laparoscopy may remain underutilized for colorectal cancer resections in the elderly. With proven benefits, increasing laparoscopy in elderly colorectal cancer patients could substantially improve outcomes. Our goal was to evaluate utilization and outcomes for laparoscopic colorectal cancer surgery in the elderly. METHODS A national inpatient database was reviewed for elective inpatient resections for colorectal cancer from 2010 to 2015. Patients were stratified into elderly (≥ 65 years) and non-elderly cohorts (< 65 years), then grouped into open or laparoscopic procedures. The main outcomes were trends in utilization by approach and total costs, length of stay (LOS), readmission, and complications by approach in the elderly. Multivariable regression models were used to control for differences across platforms, adjusting for patient demographics, comorbidities, and hospital characteristics. RESULTS Laparoscopic adoption for colorectal cancer in the elderly increased gradually until 2013, then declined, with simultaneously increasing rates of open surgery. Laparoscopy significantly improved all primary outcomes compared to open surgery (all p < 0.01). From the adjusted analysis, laparoscopy reduced complications by 30%, length of stay by 1.99 days, and total costs by $3276/admission. Laparoscopic patients were 34% less likely to be readmitted; when readmitted, the episodes were less expensive when index procedure was laparoscopic. CONCLUSION The adoption of laparoscopy for colorectal cancer surgery in the elderly is slow and even declining recently. In addition to the clinical benefits, there are reduced overall costs, creating a tremendous value proposition if use can be expanded. PRECIS This national contemporary study shows the slow uptake and recent decline in adaption of laparoscopic surgery for colorectal cancer in the elderly, despite the benefits in clinical outcomes and costs found. This data can be used to target education, regionalization, and quality improvement efforts in this expanding population.
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Care of the Geriatric Colorectal Surgical Patient and Framework for Creating a Geriatric Program: A Compendium From the 2019 American Society of Colon and Rectal Surgeons Annual Meeting. Dis Colon Rectum 2020; 63:1489-1495. [PMID: 32947418 PMCID: PMC7547896 DOI: 10.1097/dcr.0000000000001793] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Supplemental Digital Content is available in the text.
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Zhou S, Wang X, Zhao C, Liu Q, Zhou H, Zheng Z, Zhou Z, Wang X, Liang J. Laparoscopic vs open colorectal cancer surgery in elderly patients: short- and long-term outcomes and predictors for overall and disease-free survival. BMC Surg 2019; 19:137. [PMID: 31521147 PMCID: PMC6744685 DOI: 10.1186/s12893-019-0596-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/29/2019] [Indexed: 12/16/2022] Open
Abstract
Background Colorectal cancer is common in elderly patients. Laparoscopy is widely used to approach this kind of disease. This study was to examine short-term outcomes and long-term survival for laparoscopic and open surgery in elderly patients with colorectal cancer. Methods From January 2007 to December 2018, patients with colorectal cancer older than 80 operated at China National Cancer Center were included in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between open and laparoscopic surgery was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed by Cox proportional hazard model. Results Ninety-three pairs were selected after PSM. Patients in laparoscopic group had less intraoperative blood loss, postoperative complications, time to first flatus, time to oral feeding, postoperative hospital stay, and higher retrieved lymph node (P < 0.05). The OS and DFS rates were similar (P > 0.05), besides the CEA level, III/IV stage, and perineural invasion were independent predictors of survival (P < 0.05). Conclusion In elderly patients with colorectal cancer, laparoscopic surgery had better short-term outcomes than open surgery. CEA level, III/IV stage, and perineural invasion were reliable predictors for OS and DFS.
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Affiliation(s)
- Sicheng Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xuewei Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Chuanduo Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhaoxu Zheng
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhixiang Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Jung WB, Shin JY, Suh BJ. [The Short-term Outcome and Safety of Laparoscopic Colorectal Cancer Resection in Very Elderly Patients]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 69:291-297. [PMID: 28539034 DOI: 10.4166/kjg.2017.69.5.291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background/Aims Due to the recent increase in elderly population, laparoscopic surgery is more frequently performed in the elderly. This study aimed to compare the short-term outcomes of laparoscopic colorectal cancer surgery between the very elderly group (VEG), categorized as those with age over 80 years and the elderly group (EG), categorized as those with age 65 to 79 years. Methods We retrospectively compared 48 very elderly patients with 96 elderly patients (1:2 matched) who underwent laparoscopic resection for colorectal cancers at our institution between March 2010 and December 2014. The clinicopathologic parameters, surgical characteristics and short term outcomes were compared. Results There was no statistically significant difference in clinicopathologic characteristics between VEG and EG. Postoperative pain score (7 points vs. 6 points, p=0.264), time to first flatus (3 days vs. 3 days, p=0.335), hospital stay (15 days vs. 16.5 days, p=0.361), complication rates (47.9% vs. 26.0%, p=0.147) and major complication rate (25% vs. 20.8%, p=0.681) were not statistically different between the two groups. Before surgery, VEG had higher rate of neurologic underlying disease, such as dementia or cerebrovascular disease, than EG (25.0% vs. 7.3%, p=0.007). Conclusions There was no significant difference in the clinicopathologic characteristics, short-term outcomes, and complication rates for laparoscopic colorectal resection between VEG and EG, except delirium. Age over 80 years may be relevant for the application of laparoscopic colorectal cancer resection.
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Affiliation(s)
- Won Beom Jung
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Yong Shin
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byoung Jo Suh
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Abstract
Intraabdominal infections represent a diagnostic and therapeutic challenge in the elderly population. Atypical presentations, diagnostic delays, additional comorbidities, and decreased physiologic reserve contribute to high morbidity and mortality, particularly among frail patients undergoing emergency abdominal surgery. While many infections are the result of age-related inflammatory, mechanical, or obstructive processes, infectious complications of feeding tubes are also common. The pillars of treatment are source control of the infection and judicious use of antibiotics. A patient-centered approach considering the invasiveness, risk, and efficacy of a procedure for achieving the desired outcomes is recommended. Structured communication and time-limited trials help ensure goal-concordant treatment.
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Okamura R, Hida K, Hasegawa S, Sakai Y, Hamada M, Yasui M, Hinoi T, Watanabe M. Impact of intraoperative blood loss on morbidity and survival after radical surgery for colorectal cancer patients aged 80 years or older. Int J Colorectal Dis 2016; 31:327-34. [PMID: 26412248 DOI: 10.1007/s00384-015-2405-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to assess the effect of intraoperative blood loss (IBL) on short- and long-term outcomes of colorectal cancer surgery for very elderly patients. METHODS We acquired the data of consecutive patients aged 80 years or older who underwent elective radical surgery for stage I to III colorectal cancer between January 2003 and December 2007 in 41 institutions. The patients were divided into high and low IBL groups, and the differences in postoperative morbidity and survival between the two groups were primarily assessed. Eleven factors were treated as potential confounders in multivariate analyses. RESULTS A total of 1554 patients were eligible for this study, with an age range of 80-103 years. Median IBL was 71 ml (interquartile range, 25 to 200 ml), and 412 patients had IBL ≥200 ml. Morbidity was 46% among patients with IBL ≥200 ml, compared with 30 % among those with IBL <200 ml (p < 0.001). Patients with IBL ≥200 ml had worse overall survival rates and recurrence-free survival rates at 1, 3, and 5 years than those with IBL <200 ml. In multivariate analyses, IBL ≥200 ml was identified as an independent risk factor for postoperative adverse events (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.08 to 1.86), overall survival (hazard ratio (HR) 1.34, 95% CI 1.04 to 1.72), and recurrence-free survival (HR 1.29, 95% CI 1.03 to 1.62). CONCLUSION The degree of IBL is significantly associated with postoperative morbidity and survival in very elderly colorectal cancer patients.
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Affiliation(s)
- Ryosuke Okamura
- Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan.
| | - Koya Hida
- Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan
| | - Suguru Hasegawa
- Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan
| | - Madoka Hamada
- Department of Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Masayoshi Yasui
- Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - Takao Hinoi
- Department of Gastroenterological and Transplant Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Miyasaka Y, Mochidome N, Kobayashi K, Ryu S, Akashi Y, Miyoshi A. Efficacy of laparoscopic resection in elderly patients with colorectal cancer. Surg Today 2015; 44:1834-40. [PMID: 24121951 DOI: 10.1007/s00595-013-0753-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/22/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE The perioperative outcomes of laparoscopic colorectal surgery in elderly patients were compared with those of open surgery in elderly patients and those of laparoscopic surgery in nonelderly patients to evaluate the feasibility and efficacy of laparoscopic surgery in elderly patients with colorectal cancer. METHODS The data of the patients who underwent surgical resection for colorectal cancer between January 2007 and September 2012 were retrospectively collected. The clinical backgrounds and outcomes of elderly patients (≥ 70 years of age) who underwent laparoscopic surgery (EL group) were compared with those of elderly patients who underwent open surgery (EO group) and those of nonelderly patients (< 70 years of age) who underwent laparoscopic surgery (NL group). RESULTS Compared with the EO group, the EL group showed significantly less blood loss (15 versus 100 ml), fewer postoperative complications (10.7 versus 36.7 %), earlier resumption of an oral diet (4 versus 5 days) and shorter postoperative hospital stays (16 versus 28 days). A case-matched analysis showed similar results. All perioperative outcomes were equivalent between the EL and NL groups. CONCLUSIONS Laparoscopic colorectal surgery in elderly patients with cancer was not only superior to open surgery in elderly patients, but also equivalent to laparoscopic surgery in nonelderly patients in terms of the postoperative outcomes.
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Seishima R, Okabayashi K, Hasegawa H, Tsuruta M, Shigeta K, Matsui S, Yamada T, Kitagawa Y. Is laparoscopic colorectal surgery beneficial for elderly patients? A systematic review and meta-analysis. J Gastrointest Surg 2015; 19:756-65. [PMID: 25617077 DOI: 10.1007/s11605-015-2748-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/07/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Elderly patients who undergo major abdominal surgery are potentially at a higher risk of perioperative mortality and postoperative complications. Although laparoscopic surgery has been widely accepted as a less invasive surgical procedure for colorectal diseases, the benefits for elderly patients have not been validated. AIM To compare postoperative outcomes and long-term survival between laparoscopic and open colorectal surgery in the elderly population. METHODS A literature search was electronically performed to identify all studies comparing postoperative outcomes between laparoscopic and open colorectal resections in the elderly population. Primary outcomes were postoperative mortality and complications, and the secondary outcome was long-term survival. RESULTS Overall, 30 studies (70,946 patients) met our inclusion criteria. Laparoscopic surgery was significantly associated with a decreased risk of perioperative mortality [odds ratio (OR), 0.55; 95% confidence interval (CI), 0.45-0.68; P < 0.01] and postoperative complications (OR, 0.55; 95% CI, 0.48-0.63; P < 0.01) compared with open surgery. There was no significant difference in long-term survival between the two procedures (OR, 0.89; 95% CI, 0.72-1.07; P = 0.31). CONCLUSIONS Laparoscopic colorectal surgery in the elderly population has significant advantages in terms of short-term outcomes. Aggressive application of laparoscopic colorectal surgery should be considered for the elderly population.
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Affiliation(s)
- Ryo Seishima
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 1608582, Japan
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Abstract
BACKGROUND Rectal prolapse is a relatively common condition in children and elderly patients but uncommon in young adults less than 30 years old. The aim of this study is to identify risk factors and characteristics of rectal prolapse in this group of young patients and determine surgical outcome. METHODS Adult patients younger than 30 years old with rectal prolapse treated surgically between September 1994 and September 2012 were identified from an IRB-approved database. Demographics, risk factors, associated conditions, clinical characteristics, surgical management and follow-up were recorded. RESULTS Forty-four (females 32) patients were identified with a mean age of 23 years old. Eighteen (41%) had chronic psychiatric diseases requiring treatment and these patients experienced significantly more constipation than non-psychiatric patients (83% vs. 50%; P=0.024). Thirteen (30%) patients had previous pelvic surgery. The most common symptom at presentation was a prolapsed rectum in 40 (91%) and hematochezia in 24 (55%). Twenty-four (55%) underwent a laparoscopic rectopexy, 14 (32%) open abdominal repair, and 6 (14%) had perineal surgery. The most common procedure was resection rectopexy in 21 (48%; 7 open; 14 laparoscopic). At a median follow-up of 11 (range 1-165) months, 6 patients (14%) developed a recurrence. CONCLUSIONS Medication induced constipation in psychiatric patients and possible pelvic floor weakness in patients with previous pelvic surgery may be contributing factors to rectal prolapse in this group of patients.
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Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients. Surg Endosc 2014; 29:322-33. [PMID: 24986017 DOI: 10.1007/s00464-014-3672-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/06/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Increasing life expectancy requires specific attention on geriatric patients. Data support a potential reduction of surgical morbidity for patients undergoing laparoscopic surgery as compared to conventional surgery. The aim of this study was to investigate the comparative effect of laparoscopic and open colorectal surgery on geriatric patients. METHODS A systematic review of electronic information sources was undertaken. Studies that provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open colorectal surgery, were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was independently appraised by two reviewers. Random effects model was applied to synthesize outcome data. RESULTS Twenty-seven articles providing data for 66,592 patients were included in the analysis. Patients undergoing laparoscopic surgery had a decreased risk for mortality (2.2 vs. 5.4 %; OR 0.55, 95 % CI 0.44-0.67), overall morbidity (19.3 vs. 26.7 %; OR 0.54, 95 % CI 0.46-0.63), cardiac (4.7 vs. 7.7 %; OR 0.60, 95 % CI 0.39-0.92) and respiratory complications (3.9 vs. 6.3 %; OR 0.67, 95 % CI 0.47-0.95). Sensitivity analysis including reports with similar age, American Society of Anesthesiologists score and/or similar prevalence of cardiopulmonary morbidity between the laparoscopic and the open treatment arm validated the outcome estimates of the primary analysis. CONCLUSIONS This analysis supports a substantial benefit for elderly patients undergoing laparoscopic in comparison with open colorectal surgery. The comparative effect of either approach on geriatric patients with pulmonary and cardiac comorbidities is a subject of further investigation.
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Risk factor evaluation for postoperative complications in laparoscopic colorectal surgery by a classic severity grading system. Tumour Biol 2014; 35:8115-23. [PMID: 24840635 DOI: 10.1007/s13277-014-2016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/23/2014] [Indexed: 01/27/2023] Open
Abstract
Using the uniform complication grading system to evaluate postoperative complications after laparoscopic colorectal surgery is the purpose of the present study. Surgical complications were defined as grades I, II, III, IV, and V recommended by Dindo et al. Patients were categorized into three pairs: complication group (CG) and non-complication group (NCG), minor complication group (MiCG, grades I-II) and non-minor complication group (NMiCG), and major complication group (MaCG, grades III-V) and non-major complication group (NMaCG); of the 570 patients, 431 patients were discharged with no complications, and 174 complications occurred in 119 patients. The percent of grades I, II, III, IV, and V complications were 4.7, 20, 4.7, 0.7, and 0.4 %, respectively. Complications were significantly associated with male gender, larger tumor volume, and more estimated blood loss (EBL). The multivariate analysis revealed that male and EBL ≥150 ml were found to be independent predictors of postoperative complications. In subgroup analysis, patients with larger tumor volume were at significantly higher risk of postoperative major complications, and male gender and EBL ≥150 ml remained independent predictors of developing minor postoperative complications. Patients with postoperative complications would significantly experience longer hospital stay, later fluid intake, and delayed urinary catheter removal. Male, larger tumor volume, and more EBL were significant risk factors for laparoscopic colorectomy.
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16
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Abstract
Aim: The abdominal approach to rectal prolapse is associated with lower rates of recurrence but a higher chance of complications and has been traditionally reserved for younger patients. However, longer life expectancy and wider use of laparoscopic techniques necessitates another look at the abdominal approach in older patients. Methods: This was a retrospective review of data from patients undergoing abdominal repair of rectal prolapse between 2005 and 2011. Results: Forty-six abdominal repairs (laparoscopic or open suture rectopexy, sigmoidectomy and rectopexy and low anterior resection) were performed during the study period. Twenty-nine repairs (63%) were performed in patients under the age of 70 (average age 51) and 17 (37%) in patients older than 70 (average age 76; range 71–89). Most of the cases performed during the initial 3 years of the study were via laparotomy. However, in the last 4 years, the laparoscopic approach was used in 83% of younger patients and 69% of older patients. Average length of stay was 2.6 days for younger and 3.8 days for older patients. Both groups had similar rates of re-admission: 20% vs 23%. The rate of wound infection was higher in the younger patients (5% vs nil). However, rates of urinary tract infection, two instances (10%) vs four (30%), urinary retention, one instance (5%) vs two (15.4%), ileus, one instance (5%) vs two (15.4%) were higher in the older group. Conclusion: Wider use of laparoscopy has precipitated a change in the approach to rectal prolapse in older patients. Although associated with a slightly higher rate of post-operative complications, the abdominal approach to rectal prolapse is feasible, safe and effective in patients older than 70 years.
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Affiliation(s)
- Vitaliy Poylin
- Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA USA
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Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery. Surg Endosc 2013; 27:4463-8. [PMID: 23877762 DOI: 10.1007/s00464-013-3088-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/20/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Elderly patients often are regarded as high-risk for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The goal of this study was to compare the cost of care and short-term outcomes of elderly and nonelderly patients undergoing laparoscopic colectomy. Our hypothesis was that elderly patients managed with laparoscopic colorectal surgery and an enhanced recovery protocol (ERP) can realize the same benefits of lower hospital length of stay (LOS) without increasing hospital costs or readmission rates. METHODS Review of a prospective database identified all patients that underwent an elective laparoscopic colectomy from 2009 to 2012. Patients were stratified into elderly (≥70 years old) and nonelderly (<70 years old) cohorts. The main outcome measures were discharge disposition, hospital costs, hospital LOS, and 30-day readmission rates between the laparoscopic and open groups. RESULTS A total of 302 nonelderly (66%) and 153 elderly (34%) patients were included in the analysis. The elderly cohort had significantly higher comorbidities than the nonelderly group. There were no mortalities. Operative variables (procedure time, blood loss, and intraoperative complications) were similar. At discharge, significantly more elderly patients required temporary nursing or home care. There were no significant differences in short-term outcomes of LOS, 30-day readmission rates, or costs for the episode of care between the two groups. CONCLUSIONS Combining laparoscopic colectomy with an ERP is cost-effective and results in similar short-term outcomes for the elderly and nonelderly patients. Despite higher comorbidities, elderly patients realized the same benefits of shorter LOS with similar hospital costs and readmission rates.
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Grading of complications and risk factor evaluation in laparoscopic colorectal surgery. Surg Endosc 2013; 27:3748-53. [PMID: 23636522 DOI: 10.1007/s00464-013-2960-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 03/29/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND A grading system for postoperative complications is important for quality control and comparison among investigations. The objective of the current study was to evaluate complications associated with laparoscopic colorectal surgery according to a standardized grading system, and to examine risk factors associated with different complication grades. METHODS Data of all patients who underwent elective laparoscopic colorectal surgery at two medical centers between September 2003 and January 2011 were collected prospectively. Complications were graded retrospectively into five categories based on a previously proposed grading system for colorectal operations. Age, gender, BMI, Charlson comorbidity score, indication for surgery, pathology site, conversion rate, learning curve, operative times, previous abdominal surgery, concurrent surgical procedures performed, and length of hospital stay were evaluated as risk factors and outcome measures for complications. RESULTS A total of 501 patients were included in the study. Of them, 30.5 % suffered at least one complication and 6.5 % more than one. Complications that were mainly medical or surgical site infections requiring minor intervention (grades 1 and 2) occurred in 22.9 % of patients. Surgical complications requiring invasive interference (grades 3 and 4) occurred in 7.4 % of patients and mortality (grade 5) occurred in 0.2 % (1 patient). Length of hospital stay was directly related to complication grade. Average hospital stay was 6.8 ± 3.5, 10.5 ± 5.1, and 20.2 ± 12.3 days for patients with no complications, grade 1-2 complications, and grade 3-4 complications, respectively (p < 0.01). Minor complications (grades 1-2) were associated with conversion (p < 0.01), high Charlson score (p = 0.004), and additional surgical procedures (p = 0.04). Major complications (grades 3-4) were associated solely with conversion (p < 0.01) and rectal pathology (p < 0.01). CONCLUSION This study demonstrates the use of a uniform grading system for complications in laparoscopic colorectal surgery. Conversion was found to be associated with all grades of complications.
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Abstract
The acute abdomen is a common condition in older people. Half of all presentations to hospital require admission, with a third requiring immediate surgery. The Royal College of Surgeons of England have reported a worryingly high mortality rate in the over 80s undergoing emergency surgery, with a 3-fold difference in mortality throughout the England, Wales and Northern Ireland. The aim of this article is to highlight the issues that older people face in relation to acute abdominal pathology.
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Scarpa M, Di Cristofaro L, Cortinovis M, Pinto E, Massa M, Alfieri R, Cagol M, Saadeh L, Costa A, Castoro C, Bassi N, Ruffolo C. Minimally invasive surgery for colorectal cancer: quality of life and satisfaction with care in elderly patients. Surg Endosc 2013; 27:2911-20. [PMID: 23468328 DOI: 10.1007/s00464-013-2854-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 01/22/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND The purpose of this multicentric prospective study was to evaluate postoperative HRQL and satisfaction with care after laparoscopic colonic resection for colorectal cancer in elderly patients. METHODS A total of 116 patients were enrolled in this study: 33 patients older than age 70 years had laparoscopic colectomy, whereas 24 had open colectomy; 44 patients younger than age 70 years had laparoscopic colectomy and 15 of them had open colectomy. The patients answered to three questionnaires about generic (EORTC QLQ C30) and disease-specific quality of life (EORTC CR29) and about treatment satisfaction (EORTC IN-PATSAT32). Nonparametric tests and forward stepwise multiple regression analysis were used for statistical analysis. RESULTS One month after surgery, global quality of life (QL2 item) was significantly impaired in elderly patients who had laparoscopic colectomy compared with younger patients who had the same operation (p = 0.003). Similarly, role function (RF), physical function (PF), emotional function (EF), cognitive function (CF), and social function (SF) were impaired in elderly patients who had laparoscopic colectomy compared with younger patients (p < 0.001, p < 0.001, p = 0.013, p < 0.001, p = 0.01, respectively). Fatigue (FA), sleep disturbances (SL), appetite loss (AP), and dyspnea (DY) affected the quality of life of these patients more than younger patients (p < 0.001, p = 0.055, p = 0.051, and p = 0.003, respectively). CONCLUSIONS Elderly patients undergoing laparoscopic colectomy for cancer experience less postoperative local complications than elderly patients undergoing open colectomy. Nevertheless, in the first postoperative month, these patients experience a worse global quality of life than younger patients undergoing the same operation with impairment of all the functions and the presence of fatigue, sleep disturbances, appetite loss, and dyspnea.
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Affiliation(s)
- Marco Scarpa
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Via Gattamelata 64 2, 35128 Padua, PD, Italy.
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Jeong DH, Hur H, Min BS, Baik SH, Kim NK. Safety and feasibility of a laparoscopic colorectal cancer resection in elderly patients. Ann Coloproctol 2013; 29:22-7. [PMID: 23586011 PMCID: PMC3624984 DOI: 10.3393/ac.2013.29.1.22] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/06/2013] [Indexed: 12/19/2022] Open
Abstract
Purpose The aim of this study is to assess the effects of age on the short-term outcomes of a laparoscopic resection of colorectal cancer in elderly (≥75 years old), as compared with younger (<75 years old), patients. Methods A retrospective analysis of patients who underwent laparoscopic surgery for colorectal cancer between January 2007 and December 2009 was performed. There were two groups: age <75 years old (group A) and age ≥75 years old (group B). The perioperative outcomes between group A and group B were compared. Results The study included 824 patients in group A and 92 patients in group B. The body mass index (BMI) and the American Society of Anesthesiologists (ASA) score were significantly different between group B and group A (BMI: 22.5 vs. 23.5, P = 0.002; ASA score: 1.88 vs. 1.48, P = 0.001). Mean operating times were similar between the groups (325.4 minutes vs. 351.6 minutes, P = 0.07). We observed a higher overall complication rate in group B than in group A (12.0% vs. 6.2%, P = 0.047), but the number of severe complications of Accordion Severity Classification ≥3 (those that required an invasive procedure) was not significantly different between the two groups (6.5% vs. 3.4%, P = 0.142). There was no significant difference in the length of hospital stay (13.0 days vs. 12.0 days, P = 0.053). Conclusion Although the elderly patients had a significantly higher overall postoperative complication rate, no significant difference was seen in either the number of severe complications of Accordion Severity Classification ≥3 or in the length of hospital stay. A laparoscopic colorectal cancer resection in elderly patients, especially those aged 75 years or older, is safe and feasible.
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Affiliation(s)
- Duck Hyoun Jeong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Modini C, Romagnoli F, De Milito R, Romeo V, Petroni R, La Torre F, Catani M. Octogenarians: an increasing challenge for acute care and colorectal surgeons. An outcomes analysis of emergency colorectal surgery in the elderly. Colorectal Dis 2012; 14:e312-8. [PMID: 22230094 DOI: 10.1111/j.1463-1318.2012.02934.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM Emergency surgery is associated with higher mortality rates, especially in elderly patients presenting with emergent colorectal disease. The aim of this study was to determine the outcomes in elderly patients following emergency colorectal resection, with particular focus on octogenarians who presented a sixfold higher mortality rate with respect to other patients. METHOD This study examined 355 patients who underwent surgery at an Emergency Department for complications of colorectal disease between January 2007 and December 2009. Morbidity and mortality were analyzed on the basis of patients' characteristics and presentation. Univariate and logistic regression analyses were performed on morbidity and mortality risk factors. RESULTS Two-hundred and fifteen patients of > 65 years of age were included, 93 of whom were ≥ 80 years of age. The global mortality rate was 16%. In patients ≥ 80 years of age the mortality rate was 30%. The difference in mortality rate between patients < 80 years of age vs patients ≥ 80 years of age was 24%. In resected patients ≥ 80 years of age, American Society of Anesthesiology grade, colonic ischaemia, neurological comorbidity and anastomotic dehiscence were identified as independent risk factors in both univariate and logistic regression analyses. The morbidity rate was approximately 17%, and no significant difference in morbidity was found between the two groups. CONCLUSION The results of this study show that fitness status and micro vascular impairment impact significantly on mortality in the elderly, particularly in octogenarians. Although the outcomes observed were compatible with the literature, the six fold higher mortality rate observed in the most elderly patients identifies a group for which death prevention is best achieved with aggressive resuscitation and intensive postoperative care, rather than timing of surgery.
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Affiliation(s)
- C Modini
- DEAII-Emergency Department, Sapienza Università di Roma, Umberto I Policlinico di Roma, Rome, Italy
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Tan KK, Koh FHX, Tan YY, Liu JZ, Sim R. Long-term outcome following surgery for colorectal cancers in octogenarians: a single institution's experience of 204 patients. J Gastrointest Surg 2012; 16:1029-36. [PMID: 22258874 DOI: 10.1007/s11605-011-1818-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of colorectal cancer in elderly patients is likely to increase with an aging population. The aims of this study are to review our experience in the surgical management of octogenarians with colorectal cancers and to identify factors that influence the short-term and long-term outcomes. METHODS A retrospective review of all octogenarians who underwent surgery for colorectal cancer from December 2002 to October 2008 was performed. RESULTS We identified 204 patients with a median age of 84 years (range, 80-97 years). The majority of patients had an American Society of Anesthesiologists score ≥3 (n = 142, 69.6%) and a Charlson Comorbidity Index of ≤3 (n = 128, 62.7%). Emergency surgery was performed in 83 (40.7%) patients. Left-sided malignancy was seen in 138 patients (67.6%). Most of the patients had either stage II (n = 75, 36.8%) or III (n = 69, 33.8%) diseases. The 30-day mortality rate was 16.2% (n = 33). After multivariate analysis, the independent variables predicting worse perioperative complications and death were age >85 years old, emergency surgery, and Charlson Comorbidity Index >3. The median follow-up for the 171 remaining patients was 27 months (range, 2-92 months). The 30-day readmission rate was 2.9% (n = 5). Thirty-one (21.2%) of 146 patients who survived curative surgery developed recurrent disease. Seventy (34.3%) patients died from various etiologies after their first 30 days postoperatively (60% cancer-specific with median survival of 15 months and 40% noncancer-related with median survival of 14 months). Overall and disease-free survivals were adversely affected in patients with advanced malignancy and in those with severe perioperative complications. CONCLUSIONS Surgery for octogenarians with colorectal cancers is associated with significant morbidity and mortality rates which are associated with advanced age, emergency surgery, and Charlson Comorbidity Index >3. Long-term survival is dependent on the stage of the malignancy and the presence of severe perioperative complications.
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Affiliation(s)
- Ker-Kan Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Laparoscopic colectomy for carcinoma of the colon in octogenarians. J Gastrointest Surg 2011; 15:2011-5. [PMID: 21909840 DOI: 10.1007/s11605-011-1671-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 08/10/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of colorectal cancer increases with age; most patients present with resectable disease. Since there is a high morbidity rate in the elderly, the laparoscopic approach, with its lower complication rate, appears to be the ideal choice for treatment of this patient group. In this retrospective study, we aimed to compare the short-term results of laparoscopic (LC) with open (OC) colectomies for carcinoma in patients 80 years of age or older. METHODS The study comprised 93 patients aged 80 years and over who underwent OC or LC between 2005 and 2008. Demographics and clinical data were compared. RESULTS The LC group included 47, and the OC included 46 patients. No differences were found between the two groups with regard to mean age, comorbidities, and the extent of the resection. The operative time was shorter in the OC (121 vs. 157 min, P = 0.001). Hospital stay was shorter in the LC (7.6 vs. 8.8 days, P = 0.06). There were more postoperative complications in the OC (35.6%) than in the LC (30.4%), however the difference was not statistically significant (P = 0.6). CONCLUSIONS LC in the elderly is safe, with a shorter hospital stay, and carries a short-term benefit for selected patients and could be offered to all elderly patients.
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Caruso C, La Torre M, Benini B, Catani M, Crafa F, De Leo A, Neri T, Sacchi M. Is Laparoscopy Safe and Effective in Nontraumatic Acute Abdomen? J Laparoendosc Adv Surg Tech A 2011; 21:589-93. [DOI: 10.1089/lap.2011.0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlo Caruso
- Department of Biosciences, Tecnopolo di Castel Romano, Rome, Italy
| | - Marco La Torre
- Department of Biosciences, Tecnopolo di Castel Romano, Rome, Italy
| | - Bruno Benini
- Department of Emergency Surgery, Ospedale S. Camillo, Rome, Italy
| | - Marco Catani
- Department of Emergency Surgery, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Francesco Crafa
- Department of General Surgery, Ospedale Vannini, Rome, Italy
| | - Antonio De Leo
- Department of General Surgery, Ospedale Sandro Pertini, Rome, Italy
| | - Tiziano Neri
- Department of General Surgery, Ospedale Regina Apostolorum, Albano, Italy
| | - Marco Sacchi
- Department of General Surgery, Ospedale S. Maria Goretti, Latina, Italy
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Khan S, Ahmed J, Lim M, Owais A, McNaught C, Mainprize K, Babu S, Renwick I, MacFie J, Mitchell C. Colonoscopy in the octogenarian population: Diagnostic and survival outcomes from a large series of patients. Surgeon 2011; 9:195-9. [DOI: 10.1016/j.surge.2010.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/03/2010] [Accepted: 09/08/2010] [Indexed: 12/31/2022]
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Pinto RA, Ruiz D, Edden Y, Weiss EG, Nogueras JJ, Wexner SD. How reliable is laparoscopic colorectal surgery compared with laparotomy for octogenarians? Surg Endosc 2011; 25:2692-8. [PMID: 21487884 DOI: 10.1007/s00464-011-1631-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 02/21/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to the current increased longevity in the elderly population and the increased size of that population, major abdominal intervention is more frequently performed among octogenarians. This study aimed to compare the surgical and postoperative outcomes of laparoscopic colorectal resections with those of open surgery in the octogenarian population. METHODS Retrospective analysis based on a prospectively maintained database of octogenarians who underwent laparoscopic or open elective colorectal resections from 2001 to 2008 was performed. Diagnosis, comorbidities, operative data, and early postoperative complications are analyzed in this report. RESULTS Colon resection was performed for 199 octogenarians, using laparotomy for 116 patients (group 1) and laparoscopic surgery for 83 patients (group 2). The mean age was 84.3 years for the laparotomy patients and 84.7 years for the laparoscopic patients. The American Society of Anesthesiology (ASA) scores was comparable between groups 1 and 2. Colorectal adenoma was the most common indication for surgery in both groups: for 77.6% of the group 1 patients and 54.2% of the group 2 patients. Right colectomy was the most frequently performed operation in group 2: for 57.8% of the group 2 patients and 31% of the group 1 patients (p = 0.0003). Open resections had a higher mean blood loss in both group 1 (286 ml) and group 2 (152 ml) (p = 0.0002), and more patients required intraoperative transfusions (p = 0.005) despite similar operative times. The conversion rate in the laparoscopic group was 25.3%. The patients in the laparoscopic group had less morbidity, both overall and clinically, than the open group (p < 0.05). The median hospital stay was 8 days in group 1 and 6 days in group 2 (p = 0.0065). The rate of major surgical complications was similar in the two groups of patients: 6% in group 1 and 4.8% in group 2. The reoperation rate was 2.6% in group 1 and 3.6% in group 2 (p > 0.05). The mortality rate was 3.4% in group 1 and 2.4% in group 2. CONCLUSIONS Laparoscopic colorectal resection was effective and safe for octogenarians, with less blood loss and faster postoperative recovery. The morbidity rate is lower than for traditional laparotomy.
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Affiliation(s)
- Rodrigo A Pinto
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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Lee SH, Lakhtaria P, Canedo J, Lee YS, Wexner SD. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. Surg Endosc 2011; 25:2699-702. [PMID: 21479778 DOI: 10.1007/s00464-011-1632-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 02/21/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND The balance between abdominal and perineal approaches for rectal prolapse is always the higher morbidity but better outcome in the former setting. Therefore, perineal approaches have been preferred for the treatment of full-thickness rectal prolapse (FTRP) in elderly patients. However, laparoscopic rectopexy with or without resection also may be used for elderly patients and may confer the same benefits. PURPOSE The objective of this study was to evaluate safety and efficacy of laparoscopic rectopexy compared with perineal rectosigmoidectomy for FTRP in elderly patients. METHODS Between July 2000 and June 2009, eight consecutive patients (8 women; mean age, 71 (range, 65-77) years) with FTRP underwent laparoscopic rectopexy (LAP group). During the same period, 143 patients underwent perineal rectosigmoidectomy (PRS group). A total of 123 patients were selected who underwent perineal rectosigmoidectomy (117 women; mean age, 80.7 (range, 66-98) years). RESULTS Three patients (37.5%) in the LAP group and 29 patients (23.6%) in the PRS group had undergone previous operations for rectal prolapse. The mean follow-up periods were 6.9 months and 12.8 months, respectively. In the LAP group, operative time was longer (166.5 vs. 73.5 minutes; p > 0.05) and bleeding loss was more (101.7 vs. 31.6; p < 0.05), whereas the length of hospitalization was same between the two groups (5.4 vs. 5.3 days; p > 0.05). Postoperative complications included an incisional hernia in the LAP group (12.5%) and urinary retention (4.8%), anastomotic disruption (2.4%), urinary tract infection (1.6%), and atelectasis (1.6%) in the PRS group (13.8%). Recurrences were 1 (12.5%) in the LAP group and 14 (11.4%) in the PRS group. CONCLUSIONS Laparoscopic rectopexy is a safe and feasible procedure in elderly patients with FTRP but results in increased operative time.
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Affiliation(s)
- Seung-Hyun Lee
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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Hiranyakas A, Bashankaev B, Seo CJ, Khaikin M, Wexner SD. Epidemiology, Pathophysiology and Medical Management of Postoperative Ileus in the Elderly. Drugs Aging 2011; 28:107-18. [DOI: 10.2165/11586170-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
INTRODUCTION The aim of this study was to evaluate whether elderly patients with colorectal cancer benefit from laparoscopic colon surgery (LAC) in comparison to open colon surgery (OC). METHODS Patients with colon cancer were divided into four groups; >75 years (CC(>75) ) [LAC(>75) (n=36), OC(>75) (n=15)] and ≤75 years [LAC(≤75) (n=90), OC(≤75) (n=26)]. Differences in postoperative short-term outcomes were analyzed among the age and procedure groups. RESULTS Intraoperative blood loss was significantly less in the LAC(>75) group (68 ± 168 ml) than in the OC(>75) group (118 ± 130 ml, P=0.040). The C-reactive protein of patients in the OC(>75) group (5.4 ± 2.2 mg/dl) tended to be less than that of the LAC(>75) group (6.1 ± 2.8 mg/dl, P=0.080) on postoperative day 1. The time to the first passage of flatus was significantly shorter in the LAC(>75) group (2.0 ± 0.7 days) than in the OC(>75) group (2.7 ± 0.8 days, P=0.003). Postoperative hospital stays were also shorter in the LAC(>75) group (14.2 ± 9.4 days) than in the OC(>75) group (18.0 ± 8.3 days, P=0.038). No mortality was registered in the LAC(>75) group, while one patient in the OC(>75) group died during the postoperative course. The rate of postoperative morbidity was similar between the LAC(>75) and OC(>75) groups [13.9% (5/36) versus 20.0% (3/15), P=0.679]. CONCLUSION LAC provides some advantages over OC in patients with colon cancer aged >75 years as well as in those aged ≤75 years. LAC can be safely performed in very elderly patients with colon cancer.
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Affiliation(s)
- Y Tomimaru
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
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Postoperative complications in elderly patients with colorectal cancer: comparison of open and laparoscopic surgical procedures. Surg Laparosc Endosc Percutan Tech 2011; 19:488-92. [PMID: 20027093 DOI: 10.1097/sle.0b013e3181bd9562] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Surgery is associated with higher morbidity and mortality rates in elderly patients with colorectal cancer compared with younger patients. The aim of this study was to examine preoperative evaluation for selecting operative procedure in elderly patients with colorectal cancer. METHODS The study of all patients who underwent open surgery (OS) or laparoscopically assisted surgery (LAS) for colorectal cancer from January 2004 to December 2007 were aged > or =71 years. Preoperative evaluation, operative factors, morbidity, and mortality were analyzed by the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) and Prognostic Nutritional Index (PNI). RESULTS A total of 129 patients were included in this study. Fifty-one patients underwent OS, and LAS was performed on 78 patients. The morbidity rate was 51.3% (40 patients) for the OS group and 23.5% (12 patients) for the LAS group. Three LAS patients (5.9%) subsequently required OS. One LAS patient died postoperatively. There were significant differences in the Operative Severity Score (OSS) in POSSUM and PNI, but not Physiologic Score (PS) in POSSUM, between the two groups. In the OS group, there were significant differences in PS, OSS, and PNI between those with or without complications, whereas in the LAS group, OSS, but not PS or PNI, was significantly lower in those without than in those with complications. CONCLUSIONS Compared with OS, LAS is associated with a lower incidence of complications in elderly patients with colorectal cancer. The nutritional status correlated with postoperative complications in the OS group.
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Subramanian A, Balentine C, Palacio CH, Sansgiry S, Berger DH, Awad SS. Outcomes of damage-control celiotomy in elderly nontrauma patients with intra-abdominal catastrophes. Am J Surg 2011; 200:783-8; discussion 788-9. [PMID: 21146021 DOI: 10.1016/j.amjsurg.2010.07.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/01/2010] [Accepted: 07/01/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Damage-control laparotomy, initially developed for trauma patients, has expanded into the general surgery arena. Little evidence exists regarding the utility of damage-control celiotomy (DCCT) in elderly nontrauma patients. Our objective was to review the management and outcomes of DCCT in elderly patients with intra-abdominal catastrophes. METHODS Retrospective chart review from 1998 to 2008 identified cases of DCCT. Demographics, comorbidities, surgical techniques, morbidity, long-term disposition, and mortality were analyzed. RESULTS From 210 patients with emergency surgeries, 88 (42%) patients with DCCT were identified, 33 (38%) were greater than 65 years old and 55 (63%) were ≤ 65 years old. The average APACHE IV score for the elderly was 84 ± 2 versus 68 ± 2 for the younger group (p < .001). Elderly patients had significantly higher comorbidites with respect to cardiovascular, pulmonary, and renal disease. When comparing the 2 groups, there were no significant differences in-hospital or intensive care unit lengths of stay or ventilator days. There were also no significant differences in complications and disposition. Using Cox proportional hazards analysis, age was not an independent predictor of 30-day mortality. CONCLUSIONS Age is not an independent predictor of worse outcomes in patients managed by the DCCT technique after intra-abdominal catastrophes. This management technique should be considered for elderly patients who require DCCT.
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Affiliation(s)
- Anuradha Subramanian
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Veterans Affairs Hospital, Houston, TX 77030, USA.
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Abstract
At the center of the development of acute care surgery is the growing difficulty in caring for patients with acute surgical conditions. Care demands continue to grow in the face of an escalating crisis in emergency care access and the decreasing availability of surgeons to cover emergency calls. To compound this problem, there is an ever-growing shortage of general surgeons as technological advances have encouraged subspecialization. Developed by the leadership of the American Association for the Surgery of Trauma, the specialty of acute care surgery offers a training model that would produce a new breed of specialist with expertise in trauma surgery, surgical critical care, and elective and emergency general surgery. This article highlights the evolution of the specialty in hope that these acute care surgeons, along with practicing general surgeons, will bring us closer to providing superb and timely care for patients with acute surgical conditions.
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Tan KY, Konishi F, Kawamura YJ, Maeda T, Sasaki J, Tsujinaka S, Horie H. Laparoscopic colorectal surgery in elderly patients: a case-control study of 15 years of experience. Am J Surg 2010; 201:531-6. [PMID: 20605135 DOI: 10.1016/j.amjsurg.2010.01.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 08/09/2009] [Accepted: 01/05/2010] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of this study was to review the impact of age (≥75 years) on the short-term outcomes of laparoscopic colorectal surgery. METHODS Three hundred seventy-nine patients under 70 years of age and 91 patients 75 years and older were analyzed. Quantification of comorbidities was performed using the Charlson Weighted Comorbidity Index. Outcome measures were postoperative complications and 30-day mortality. RESULTS There was no difference in the occurrence of postoperative complications between the younger and older patients. Bivariate analysis revealed that patient age was not a risk factor of major complications (odds ratio = 1.2; 95% confidence interval, .6-2.3). Although bivariate analysis revealed that older age had a statistically significant odds ratio for 30-day mortality (odds ratio = 12.8; 95% confidence interval, 1.3-125.4), multivariate analysis revealed that it was a weighted comorbidity index score of 5 or more (P = .02) and long operative time (P = .01) that were independent predictors of 30-day mortality and not age per se. CONCLUSIONS Age is not an independent predictor of morbidity and mortality in laparoscopic colorectal cancer surgery.
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Affiliation(s)
- Kok-Yang Tan
- Department of Surgery, Saitama Medical Centre, Jichi Medical School, Omiyaku, Saitamashi, Japan
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Kurian AA, Suryadevara S, Vaughn D, Zebley DM, Hofmann M, Kim S, Fassler SA. Laparoscopic colectomy in octogenarians and nonagenarians: a preferable option to open surgery? JOURNAL OF SURGICAL EDUCATION 2010; 67:161-166. [PMID: 20630427 DOI: 10.1016/j.jsurg.2010.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/08/2010] [Accepted: 02/26/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine if laparoscopic colectomy is safer and more effective than open colectomy in patients older than 80 years of age. METHODS An operating room database of all colectomies performed on patients >or=80 years, from January 2002 to September 2007, was analyzed retrospectively. Data reviewed included type of operation, type of resection, length of procedure, length of stay (LOS), estimated blood loss, American Society of Anesthesiologists (ASA) grade, diagnosis, complications, mortality rates, and discharge destination, with p-values <0.05 considered significant. RESULTS One hundred thirty-nine patients underwent open procedures (Open group) during the study period versus 150 patients who underwent laparoscopic procedures (Lap group). Of the Lap group, 15 patients were converted to open cases. Forty-four patients from the Open group were excluded from the analysis as they were treated emergently, leaving 95 patients in the Open group. The mortality for open procedures was significantly higher at 9/95 (9.4%), compared with 3/150 (2%) following laparoscopic procedures (p = 0.0132). LOS was significantly longer for open procedures (11.16 days) versus laparoscopic procedures (7.11 days), p = 0.0001. Open procedures were associated with an increased risk of postoperative ileus (p < 0.02). The Open group had a higher likelihood of discharge to a nursing facility (43/87) than the Lap group (33/147), p < 0.0001. There were no significant differences in the length of procedure, estimated blood loss and postoperative complications. CONCLUSIONS Laparoscopic colectomy is a safer option that offers an improved outcome compared with open colectomy in elderly patients. Significant improvements in LOS, mortality rates, and discharge destination were observed.
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Affiliation(s)
- Ashwin A Kurian
- Department of Surgery and the Muller Center for Senior Health, Abington Memorial Hospital, Abington, Pennsylvania, USA
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Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg 2010; 4:5. [PMID: 20338045 PMCID: PMC2852382 DOI: 10.1186/1754-9493-4-5] [Citation(s) in RCA: 252] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 03/25/2010] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Open or laparoscopic colorectal surgery comprises of many different types of procedures for various diseases. Depending upon the operation and modifiable and non-modifiable risk factors the intra- and postoperative morbidity and mortality rate vary. In general, surgical complications can be divided into intraoperative and postoperative complications and usually occur while the patient is still in the hospital. METHODS A literature search (1980-2009) was carried out, using MEDLINE, PubMed and the Cochrane library. RESULTS This review provides an overview how to identify and minimize intra- and postoperative complications. The improvement of different treatment strategies and technical inventions in the recent decade has been enormous. This is mainly attributable to the increase in the laparoscopic approach, which is now well accepted for many procedures. Training of the surgeon, hospital volume and learning curves are becoming increasingly more important to maximize patient safety, surgeon expertise and cost effectiveness. In addition, standardization of perioperative care is essential to minimize postoperative complications. CONCLUSION This review summarizes the main perioperative complications of colorectal surgery and influencable and non-influencable risk factors which are important to the general surgeon and the relevant specialist as well. In order to minimize or even avoid complications it is crucial to know these risk factors and strategies to prevent, treat or reduce intra- and postoperative complications.
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Affiliation(s)
- Philipp Kirchhoff
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Switzerland.
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Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Hewett PJ, Rieger NA, Smith JS, Solomon MJ, Stevenson ARL. Australasian Laparoscopic Colon Cancer Study shows that elderly patients may benefit from lower postoperative complication rates following laparoscopic versus open resection. Br J Surg 2009; 97:86-91. [PMID: 19937975 DOI: 10.1002/bjs.6785] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A retrospective analysis of age-related postoperative morbidity in the Australia and New Zealand prospective randomized controlled trial comparing laparoscopic and open resection for right- and left-sided colonic cancer is presented. METHODS A total of 592 eligible patients were entered and studied from 1998 to 2005. RESULTS Data from 294 patients who underwent laparoscopic and 298 who had open colonic resection were analysed; 266 patients were aged less than 70 years and 326 were 70 years or older (mean(s.d.) 70.3(11.0) years). Forty-three laparoscopic operations (14.6 per cent) were converted to an open procedure. Fewer complications were reported for intention-to-treat laparoscopic resections compared with open procedures (P = 0.002), owing primarily to a lower rate in patients aged 70 years or more (P = 0.002). Fewer patients in the laparoscopic group experienced any complication (P = 0.035), especially patients aged 70 years or above (P = 0.019). CONCLUSION Treatment choices for colonic cancer depend principally upon disease-free survival; however, patients aged 70 years or over should have rigorous preoperative investigation to avoid conversion and should be considered for laparoscopic colonic resection. REGISTRATION NUMBER NCT00202111 (http://www.clinicaltrials.gov).
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Affiliation(s)
- R A Allardyce
- Department of Surgery, University of Otago, Christchurch, New Zealand.
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Stechman MJ, Roy D, Mainprize KS. Current practice in the United Kingdom for the use of diagnostic laparoscopy in suspected acute appendicitis. Colorectal Dis 2009; 11:817-20. [PMID: 19175657 DOI: 10.1111/j.1463-1318.2008.01716.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Diagnostic laparoscopy is advocated in the management of patients with acute right iliac fossa pain. We asked consultant surgeons in the UK about their current use of this technique. METHOD A short anonymous questionnaire was sent to consultant surgeons from the ASGBI database. Information was sought on general surgical specialty, participation in the emergency surgical on-call rota, current practice regarding the use of diagnostic laparoscopy in patients with suspected acute appendicitis and on the management of an inflamed or noninflamed appendix. Statistical analysis was by means of chi(2) test. RESULTS There were 161 eligible returns from 250 questionnaires (64%) and the proportion of consultants replying from each subspecialty was similar to membership numbers of subspecialty organizations. Most consultants (68%) performed diagnostic laparoscopy in patients with suspected acute appendicitis. The majority (69%) reserved its use for women of reproductive age and 14% of respondents laparoscoped all patients with suspected appendicitis. Compared to nongastrointestinal (GI), GI surgeons were significantly more likely to perform diagnostic laparoscopy (75 vs 52%, P = 0.008). In the case of an overtly inflamed appendix, 81% of respondents would remove it laparoscopically with significantly more GI surgeons following this course than nonGI surgeons (P = 0.04). CONCLUSION Despite good evidence on the benefits of diagnostic laparoscopy in certain patients with suspected acute appendicitis, there is significant variation in its use. This difference appears to be based upon subspecialty and may be as a result of increasing subspecialization.
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Affiliation(s)
- M J Stechman
- Department of Surgery, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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Laparoscopic Surgery For Colon Cancer - A Favorite Method? A Review of Literature. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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