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Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Minimally invasive surgery improves short-term outcomes in elderly colorectal cancer patients
Celia N Robinson1, Courtney J Balentine, Christy L Marshall
1Department of Surgery Michael E DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA.
Background:
Minimally invasive surgery (MIS) for colorectal resection has been shown to improve short-term outcomes compared with open surgery in patients with colorectal cancer. Currently, there is a paucity of data demonstrating similar efficacy between MIS and open colorectal resection in the elderly population. We hypothesized that minimally invasive surgery provides improved short-term outcomes in elderly patients with colorectal cancer.
Methods:
A review of 242 consecutive elderly (≥ 65 y of age) patients who underwent either open or MIS colorectal resection for adenocarcinoma at one institution was conducted. Short-term and oncologic outcomes were analyzed. Continuous variables were analyzed by the Mann-Whitney U test. Categorical variables were compared by χ(2) tests. Survival was compared by the Kaplan-Meier method using the log rank test for comparison.
Results:
Of the 242 elderly patients with colorectal cancer (median American Society of Anesthesiology score (ASA) scores of 3), 80% (n = 195) of patients underwent open and 20% (n = 47) had MIS colorectal cancer resections. Patients undergoing MIS had a faster return of bowel function, decreased days to nasogastric tube removal, decreased days to flatus and bowel movement, and quicker advancement to clear liquid and regular diets. The overall length of hospital stay in the MIS group was decreased by 40% as well as a trend towards a 50% decrease in SICU stay. Additionally, there was 66% decrease in cardiac complications in the MIS group. When evaluating for oncologic adequacy as measured by number of lymph nodes and surgical resection margins, MIS surgery offered equivalent results as open resection. Furthermore, there was no significant difference in overall survival for MIS versus open colorectal surgery.
Conclusion:
Minimally invasive colorectal cancer resection leads to improved short-term outcomes as demonstrated by decreased length of hospital stay and faster return of bowel function. Additionally, there appears to be no difference in oncologic outcomes in the elderly. On the basis of our data, age alone should not be a contra-indication to laparoscopic colorectal cancer resection.
Insights
Minimally invasive surgery (MIS) for colorectal cancer in elderly patients shows faster recovery and shorter hospital stays. Oncologic outcomes and survival rates are comparable to open surgery, suggesting age is not a barrier to MIS.
Area of Science:
- Colorectal surgery
- Oncology
- Geriatric surgery
Background:
- Minimally invasive surgery (MIS) improves short-term outcomes in colorectal cancer patients.
- Limited data exists on MIS efficacy in elderly colorectal cancer patients.
- This study investigates MIS benefits in elderly patients (≥ 65 years).
Purpose of the Study:
- To compare short-term and oncologic outcomes of MIS versus open colorectal resection in elderly patients.
- To determine if age is a contraindication for MIS in colorectal cancer surgery.
Main Methods:
- Retrospective review of 242 elderly patients undergoing open or MIS colorectal resection for adenocarcinoma.
- Analysis of short-term outcomes (e.g., bowel function, diet advancement, hospital stay) and oncologic outcomes (lymph node count, resection margins).
- Statistical analysis using Mann-Whitney U, Chi-squared, and Kaplan-Meier methods.
Main Results:
- MIS group (20%) showed faster return of bowel function, quicker diet advancement, and a 40% shorter hospital stay.
- MIS was associated with a 66% reduction in cardiac complications and a trend towards decreased SICU stay.
- Oncologic outcomes, including lymph node retrieval and resection margins, were equivalent between MIS and open surgery.
- No significant difference in overall survival was observed between the two surgical approaches.
Conclusions:
- Minimally invasive colorectal cancer resection offers improved short-term outcomes in elderly patients.
- MIS provides comparable oncologic adequacy and survival rates to open surgery in this population.
- Age should not preclude elderly patients from undergoing laparoscopic colorectal cancer resection.
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