Minimally invasive surgery in elderly patients with rectal cancer: An analysis of the Bi-National Colorectal Cancer Audit (BCCA).

Autor: van Harten MJ; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Greenwood EB; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Bedrikovetski S; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia., Dudi-Venkata NN; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia., Hunter RA; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Kroon HM; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: Hidde.Kroon@SA.GOV.AU., Sammour T; Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2020 Sep; Vol. 46 (9), pp. 1649-1655. Date of Electronic Publication: 2020 Apr 03.
DOI: 10.1016/j.ejso.2020.03.224
Abstrakt: Background: Advanced age is associated with worse outcomes after open rectal cancer surgery. However, not much is known about outcomes of minimally invasive surgery (MIS) in the elderly. The aim of this study was to evaluate safety and efficacy of MIS in elderly rectal cancer patients using the Bi-national Colorectal Cancer Audit (BCCA) data from Australia and New Zealand (ANZ).
Methods: 3451 patients were included, divided into three groups: <50 years (n = 364), 50-74 years (n = 2157) and ≥75 years (n = 930). Propensity-score matching was performed for the elderly group analysis to correct for differences in baseline characteristics.
Results: MIS was performed in 52.9% of elderly patients, slightly lower than rates in <50 year and 50-74 year old groups (61% and 55.5%, respectively, p = 0.022). Elderly patients had more postoperative complications (p < 0.0001) and had a longer length of hospital stay (LOS; median 11 vs. 8 days for both other groups; p < 0.0001). Elderly patients had higher (y)pT-stages compared to both other groups (p < 0.0001) and were less likely to receive adjuvant therapy (p < 0.0001). Propensity-score matched analysis of the elderly group showed a higher rate of superficial wound dehiscence and a longer LOS after open surgery compared to MIS (10.3% vs. 2.6%, p = 0.030; 12 days vs. 9.5 days, p = 0.001, respectively), with comparable short-term oncological outcomes.
Conclusions: MIS is performed in just over half of elderly rectal cancer patients who are selected for elective rectal resection surgery in ANZ. When performed in the elderly, MIS appears safe and is associated with fewer wound complications and a shorter LOS.
Competing Interests: Declaration of competing interest None.
(Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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