Laparoscopic Versus Open Surgery for Colorectal Cancer in Elderly Patients: A Multicenter Matched Case–Control Study
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The safety of laparoscopic surgery (LAP) in elderly patients with colorectal cancer has not been demonstrated. The aim of this study was to compare the outcomes of LAP and open surgery (OP) and estimate the feasibility of LAP in colorectal cancer patients aged ≥80 years.
We conducted a propensity scoring matched case–control study of colon and rectal cancer patients aged ≥80 years using data from 41 hospitals between 2003 and 2007. A total of 1,526 colon cancer patients and 282 rectal cancer patients underwent surgery and were included in the analysis. The primary end point was 3-year overall survival (OS). Secondary end points included disease-free survival (DFS), cancer-specific survival (CSS), and postoperative complications.
LAP and OP were compared in 804 colon cancer patients (402 pairs) and 114 rectal cancer patients (57 pairs) after all covariates were balanced, and no significant differences were observed, except for tumor size in colon cancer. OS, DFS, and CSS did not differ between the groups for either colon cancer (P = 0.916, 0.968, and 0.799, respectively) or rectal cancer (P = 0.765, 0.519, and 0.950, respectively). In colon cancer cases, LAP was associated with fewer morbidities than was OP (24.9 vs. 36.3 %, P < 0.001); no such difference was observed for rectal cancer patients (47.4 vs. 40.4 %, P = 0.450).
LAP is an acceptable alternative to OP in elderly patients with colorectal cancer.
KeywordsOverall Survival Rectal Cancer Propensity Score Surgical Site Infection Postoperative Chemotherapy
We acknowledge the cooperation of the following doctors: Eiji Kanehira, Kunihisa Shiozawa, Ageo Central General Hospital; Hiroyuki Bando, Daisuke Yamamoto, Ishikawa Prefectural Central Hospital; Seigo Kitano, Masafumi Inomata, Tomonori Akagi, Oita University; Junji Okuda, Keitaro Tanaka, Osaka Medical College; Masayoshi Yasui, Osaka National Hospital; Kosei Hirakawa, Kiyoshi Maeda, Osaka City University; Akiyoshi Kanazawa, Osaka Red Cross Hospital; Junichi Hasegawa, Junichi Nishimura, Osaka Rosai Hospital; Ichio Suzuka, Kagawa Prefectural Central Hospital; Shintaro Akamoto, Kagawa University; Yosuke Fukunaga, Hiroya Kuroyanagi, Cancer Institute Ariake Hospital; Masaki Naito, Kitasato University; Takashi Ueki, Kyushu University; Takashi Yamaguchi, Koya Hida, Kyoto Medical Center; Yousuke Kinjo, Kyoto University; Yukihito Kokuba, Kyoto Prefectural University; Madoka Hamada, Kochi Health Sciences Center; Norio Saito, Masaaki Ito, National Cancer Hospital East; Jou Tashiro, Saitama Medical University; Toshimasa Yatsuoka, Saitama Cancer Center; Tomohisa Furuhata, Kenji Okita, Sapporo Medical University; Yoshiro Kubo, Shikoku Cancer Center; Shuji Saito Yosuke Kinugasa, Shizuoka Cancer Center; Fumio Konishi, Saitama medical Center Jichi Medical University; Michitoshi Goto, Juntendo University; Junichi Tanaka, Shungo Endo, Showa University Northern Yokohama Hospital; Nobuyoshi Miyajima, Tadashi Suda, Tsukasa Shimamura, St. Marianna University; Yoshihisa Saida, Toshiyuki Enomoto, Toho University Ohashi Medical Center; Takeshi Naito, Tohoku University; Yasuhiro Munakata, Souichi Tagami, Nagano Municipal Hospital; Satoshi Maruyama, Niigata Cancer Center Hospital; Takao Ichihara, Nishinomiya Municipal Central Hospital; Hitoshi Idani, Fukuyama Municipal Hospital; Yasuhiro Miyake, Minoh City Hospital; Shoichi Hazama, Yamaguchi University; and Kazuteru Watanabe, Yokohama City University Medical Center. This study was supported by the Japanese Society for Cancer of the Colon and Rectum.
The authors declare no conflict of interest.
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