The large randomized control trials listed above compared laparoscopic surgery to open surgery, but they did not include elderly patients. Many studies have shown significant short-term outcomes and a low morbidity/mortality rate, allowing elderly people who underwent laparoscopic surgery to return to their normal lives in a short time. Prospective studies comparing the long-term outcomes of laparoscopic surgery against open surgery in elderly people are rare.
The goal of this study was to see if these short-term results may also increase the long-term oncologic benefits of older individuals who underwent laparoscopic surgery. At a single academic medical center, we retrospectively evaluated the short- and long-term survival results of patients with CRC aged 75 years or older who underwent open surgery versus laparoscopic surgery.
Variables and Patients
This study included individuals over the age of 75 who underwent curative radical resection for primary colorectal cancer between January 2009 and December 2015. Patients who had a local tumor removed were diagnosed with stage IV cancer, or had an emergency procedure were not included in this study.
For the study, a total of 967 participants were included. 305 patients got laparoscopic surgery, whereas 662 underwent open laparotomy surgery. The choice of laparoscopic versus open surgery was made based on the preferences of both the surgeon and the patient. Because of improvements in laparoscopic facilities and equipment, as well as a rising number of surgeons who choose laparoscopic radical resection as the first choice of treatment for elderly CRC patients, the penetration rate of laparoscopic surgery has gradually increased year after year.
Those who had laparoscopic surgery had a considerably shorter postoperative stay (10.3 vs. 13.5 days, p 0.001), as well as equivalent postoperative morbidity (p = 0.354) and death (p = 0.082) than those who had open surgery. Six of the 305 patients in the laparoscopy group had to undergo open surgery, and one died. Both cohorts in each stage had comparable long-term overall survival, cancer-specific survival, and recurrence rates. Advanced Colorectal and General Surgery remains as one of the most affordable options for a colorectal specialist in Singapore.
Because of the shorter postoperative stay, equal long-term outcomes to open surgery, and tolerable low conversion rates, laparoscopic surgery is appropriate for elderly individuals. In each TNM stage, the results of laparoscopic surgery were similar to those of open surgery in terms of long-term overall and oncological outcomes.