Impact of laparoscopic approach on the short-term outcomes of elderly patients with colorectal cancer: a nationwide Ital
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and Other Interventional Techniques
Impact of laparoscopic approach on the short‑term outcomes of elderly patients with colorectal cancer: a nationwide Italian experience Andrea Barina1 · Marco Nardelli1 · Nicola Gennaro2 · Maria Chiara Corti2,3 · Francesco Marchegiani1 · Cristina Basso2 · Eliana Ferroni2 · Ugo Fedeli2 · Gaya Spolverato1 · Salvatore Pucciarelli1 Received: 29 March 2019 / Accepted: 9 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Introduction The laparoscopic approach is increasingly adopted in colorectal cancer surgery; however, its role in elderly patients is controversial. We sought to examine the relationship between age and short-term outcomes following laparoscopic surgery for colorectal cancer (CRC). Methods Data of patients 65 + years old who underwent laparoscopic surgery for CRC between 2002 and 2014 were retrieved from the administrative National Italian Hospital Discharge Dataset. Patients were divided into three age categories (65–74, 75–84, and 85 +). The impact of age on length of stay, 30-day readmission, in-hospital mortality, and postoperative complications was evaluated. Results During the study period, 47,704 patients underwent laparoscopic surgery for CRC. The median postoperative length of stay was 9 days, and 30-day readmission and in-hospital mortality were 4.4% and 0.9%, respectively. Age was found to be an independent risk factor of prolonged length of stay and increased in-hospital mortality. With respect to patients in 65–74 years age category, patients aged 75–84 years and those aged 85 + years had a higher risk of complications (OR 1.43, 95% CI 1.36–1.50, and OR 2.00, 95% CI 1.83–2.17, respectively). However, no statistically significant association was found between age and anastomotic leakage or surgical site infection (p = 0.29, and p = 0.58, respectively). Conclusions In patients with CRC who underwent laparoscopic surgery, age was found to be an independent risk factor for prolonged length of stay, in-hospital mortality, and global postoperative complications. These findings should be considered when planning laparoscopic surgery in elderly patients. Keywords Colorectal surgery · Laparoscopic surgery · Short-term outcomes · Elderly
Andrea Barina and Marco Nardelli equally contributed to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-019-07197-9) contains supplementary material, which is available to authorized users. * Gaya Spolverato [email protected] 1
1st Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35121 Padua, Italy
2
Regional Epidemiology Service, Padua, Azienda Zero, Italy
3
AGENAS National Outcome Program, Rome, Italy
Colorectal cancer (CRC) is the third most common malignancy with 1,096,601 (6.1%) new cases of colon cancer, and 704,376 (3.9%) new cases of rectal cancer in the 2018. Moreover, it is the second cause of cancer-related m
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