Evaluation of short- and long-term outcomes following laparoscopic surgery for colorectal cancer in elderly patients age
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ORIGINAL ARTICLE
Evaluation of short- and long-term outcomes following laparoscopic surgery for colorectal cancer in elderly patients aged over 80 years old: a propensity score-matched analysis Toshinori Sueda 1 & Mitsuyoshi Tei 1 & Kentaro Nishida 1 & Yukihiro Yoshikawa 1 & Tae Matsumura 1 & Chikato Koga 1 & Masaki Wakasugi 1 & Hiromichi Miyagaki 1 & Ryohei Kawabata 1 & Masanori Tsujie 1 & Junichi Hasegawa 1 Accepted: 1 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose It remains controversial whether the advantages of laparoscopic surgery for colorectal cancer (CRC) are beneficial in elderly patients (EP, age ≥ 80 years). The present study aimed to evaluate whether age itself is an independent risk factor for laparoscopic surgery by comparing short- and long-term outcomes between non-EP and EP groups. Methods We retrospectively analyzed 730 consecutive patients with stage I–III CRC who had undergone elective surgery between 2010 and 2017, using propensity score–matched analysis. Results Median follow-up was 49 months. After matching, we enrolled 228 patients. In the matched cohort, estimated operative time, estimated blood loss, lymph node dissection ≥ D3, number of lymph nodes harvested < 12, conversion rate, multivisceral resection rate, postoperative complication rate, and length of postsurgical stay were similar between the two groups. Before matching, compared with the non-EP group, the EP group had significantly shorter overall survival (OS) (p < 0.01), cancerspecific survival (CSS) (p < 0.01), recurrence-free survival (RFS) (p < 0.01), and higher frequency of local recurrence (LR) (p = 0.01); however, there was no significant difference in terms of incidence of LR or CSS between the two groups in the matched cohort. Prior to matching, multivariate analysis identified age ≥ 80 years as an independent prognostic factor for OS (p < 0.01), CSS (p < 0.01), and RFS (p = 0.01); however, after matching, age ≥ 80 years was not an independent poor prognostic factor for OS or CCS. Conclusions Laparoscopic surgery offers a safe, effective option for CRC in EP aged ≥ 80 years. Keywords Colorectal cancer . Laparoscopic surgery . Elderly . Propensity score matching . Oncological outcomes
Introduction Recent statistics from the World Health Organization show that colorectal cancer (CRC) is one of the most common types of cancer worldwide [1]. In developed countries, life expectancy and the size of the elderly population have increased steadily in recent decades [2–4]. This is also the case in Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03770-0) contains supplementary material, which is available to authorized users. * Toshinori Sueda [email protected] 1
Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka 591-8025, Japan
Japan, where those aged ≥ 80 years account for 8.9% of the total Japanese population (as of September 2019) [5]; thus, the mean age of patients who are diagnosed with
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