Laparoscopic CRC surgery ‘beneficial’ for octogenarians
MedWire News: Age is no barrier to laparoscopic large bowel resection for colorectal cancer (CRC), say UK researchers who found that octogenarian and nonagenarian patients may benefit from the procedure.
"This paper highlights the fact that elective surgery in the 'very old' is safe and has acceptable morbidity and mortality," report Baber Naseer Chaudhary (Frenchay Hospital, Bristol) and co-workers.
"Patients with [CRC] should not be denied laparoscopic surgery based on chronological age alone."
The team followed up 173 elderly patients, including 80 men, who underwent laparoscopic CRC surgery between December 2000 and October 2009 at one of three units.
The patients were aged between 80 and 93 years, with a median age of 84 years, and a median body mass index of 26 kg/m2. The majority had an American Society of Anesthesiologists (ASA) grade 2 status (n=87, mild systemic disease) or grade 3 (n=68, severe systemic disease).
Conversion to open surgery occurred in just 7.5% of patients, mainly due to bleeding or adhesions, the researchers report in Colorectal Disease.
The patients had a median hospital stay of 5 days. Twelve percent of patients experienced major complications, including renal failure or urinary tract infection (n=7), wound infection (n=6), and respiratory failure or infection (n=7).
A further 5.8% of patients were readmitted to hospital after discharge for complications, such as wound infection (n=2), nausea and vomiting (n=2), or need for extra social care (n=1). Three (1.7%) patients died within 30 days of surgery, attributed to cardiac arrest following pelvic bleeding, pneumonia, and myocardial infarction.
Acknowledging that elderly patients may refuse CRC surgery, Chaudhary et al comment: "It would be reasonable to suggest that some patients may decide against a surgical resection based on misunderstanding, misinformation or perhaps even a sense of fatalism associated with their advanced age and concurrent illnesses.
"This fatalism is often supported by the patient's family and surgeon."
They counter this belief, concluding: "Laparoscopic surgery of colorectal cancer in expert hands leads to very good results in very elderly patients who would be considered to be at high risk for open surgery."
By Lynda Williams