Is laparoscopic colorectal surgery safe also in elderly patients?

Abstract

Introduction: Aging is a lifelong irreversible biological process. At the end of 2016, almost two million residents older than 65 years lived in the
Czech Republic (18.8% of the population). Today, surgery in patients over 80 years of age is no exception. The laparoscopic approach in colorectal
surgery could bring benefits also in a reasonably selected group of geriatric patients. The aim of this study was to find out whether laparoscopic
colorectal surgery is safe in elderly patients.
Method: A retrospective analysis was performed of 1175 medical records of patients undergoing elective colon or rectal resection from 2010 to
2016 using the laparoscopic or open technique. The monitored data included characteristics of the patients, surgical diagnostic data, data related
to the procedure and evaluation of the postoperative period including any complications. Clavien-Dindo classification was used to assess the severity of postoperative complications. The postoperative complications were analyzed in relation to the age (<75 years, ≥75 years) and operative technique (laparoscopic, open).
Results: The duration of surgery was significantly longer in the laparoscopic group aged 75 years or older. The postoperative complications rate,
morbidity and mortality increased in the open group with age. A statistically significant difference was observed in morbidity in the open technique group (44% vs 34%, p=0.046), without any significant difference in mortality. In the laparoscopic group, there was no significant difference in morbidity (36% vs 32%, not significant) and letality copied the situation observed in laparotomic procedures. The lower incidence of postoperative complications in laparoscopic procedures, particularly in patients over 75 years of age, was reflected in a significant shortening of the length of hospital stay. A significantly lower incidence of less serious postoperative complications (Clavien-Dindo I-II) was confirmed in the laparoscopic group in elderly patients.
Conclusion: Among others, ageing is associated with an increasing number of elderly patients with colorectal diseases, especially with colorectal
cancer or complicated diverticular disease. As follows from this article, the laparoscopic approach in colorectal surgery is as safe and effective as
the laparotomic (open) approach. Moreover, laparoscopic surgery is associated with reduced pain, faster recovery of activity of the gastrointestinal tract, more rapid recovery and thus a reduced risk of some postoperative complications such as early infections.