Indications for laparoscopic surgery for older rectal cancer patients with comorbidities
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ORIGINAL ARTICLE
Indications for laparoscopic surgery for older rectal cancer patients with comorbidities Yuichi Hisamatsu1 · Naotaka Kuriyama1 · Yoshiaki Fujimoto1 · Tomoko Jogo1 · Qingjiang Hu1 · Kentaro Hokonohara1 · Ryota Nakanishi1 · Koji Ando1 · Yasue Kimura1 · Eiji Oki1 · Masaki Mori1 Received: 23 June 2020 / Accepted: 20 August 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Given the lack of safety studies concerning laparoscopic surgery for rectal cancer in patients ≥ 80 years old with comorbidities, we sought to investigate this in the current study. Methods Between 2012 and 2019, 24 patients ≥ 80 years old underwent laparoscopic surgery for rectal cancer without preoperative treatment. These patients were divided into those with [comorbidity(+) group, n = 13] and without [comorbidity(−) group, n = 11] comorbidities. The preoperative nutritional status and ASA classification, postoperative complications, time to oral diet, and length of hospital stay were evaluated in each group. Results In the comorbidity(+)/comorbidity(−) groups, the average age was 85.9/84.1 years old, respectively. The major comorbidities were heart disease including atrial fibrillation and valvular disorder. The average PNI and CONUT scores in the comorbidity(+)/comorbidity(−) groups were 44.7/44.2 an 3.1/2.2, respectively. Planned surgical procedures were completed in all patients. Postoperative complications occurred in 2/3 cases in the comorbidity(+)/comorbidity(−) groups, respectively, and the average time to oral diet was 3.8/3.7 days, while the average length of hospitalization after surgery was 15.2/16.5 days, respectively. In the comorbidity(+) group, there was no exacerbation of comorbidities in any cases. Conclusion The safety of laparoscopic surgery is acceptable among older rectal cancer patients with comorbidities. Keywords Older patients · Rectal cancer · Laparoscopic surgery · Comorbidities
Introduction Rectal cancer is the most common type of malignant tumor in the digestive tract and one of the leading causes of death in humans. It mainly occurs in people over 45 years old, and the incidence is higher in males than in females [1, 2]. With the increase in the aging population, the proportion of older patients with rectal cancer is gradually rising, but the treatment of older patients with rectal cancer has not been well studied [3]. Older patients have a higher rate of preoperative concomitant diseases, lower preoperative respiratory function, lower preoperative laboratory data, and higher American Society of Anesthesiologists (ASA) scores than younger patients
[4–6]. They also have poorer preoperative conditions than younger counterparts. Therefore, minimally invasive surgery is expected to be an effective treatment approach for older patients. Several studies have reported that in colorectal cancer cases, laparoscopic surgery shows comparable oncological results and improved short-term outcomes compared with open surgery [7–9]. However, the safety of older patients with comorbidities underg
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