Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case-control study in Japan.

Autor:	Niitsu, Hiroaki, Hinoi, Takao, Kawaguchi, Yasuo, Ohdan, Hideki, Hasegawa, Hirotoshi, Suzuka, Ichio, Fukunaga, Yosuke, Yamaguchi, Takashi, Endo, Shungo, Tagami, Soichi, Idani, Hitoshi, Ichihara, Takao, Watanabe, Kazuteru, Watanabe, Masahiko, Japan Society of Laparoscopic Colorectal Surgery
Předmět:	LAPAROSCOPIC surgery COLON cancer patients HEALTH outcome assessment DISEASES in older people RETROSPECTIVE studies ADENOCARCINOMA CANCER invasiveness COLECTOMY COLON tumors COMPARATIVE studies LAPAROSCOPY RESEARCH methodology MEDICAL cooperation METASTASIS RECTUM tumors RESEARCH SURVIVAL analysis (Biometry) TUMOR classification EVALUATION research TREATMENT effectiveness SEVERITY of illness index CASE-control method
Zdroj:	Journal of Gastroenterology; Jan2016, Vol. 51 Issue 1, p43-54, 12p, 1 Diagram, 4 Charts, 1 Graph
Abstrakt:	Background: It remains controversial whether open or laparoscopic surgery should be indicated for elderly patients with colorectal cancer and a poor performance status.Methods: In those patients aged 80 years or older with Eastern Cooperative Oncology Group performance status score of 2 or greater who received elective surgery for stage 0 to stage III colorectal adenocarcinoma and had no concomitant malignancies and who were enrolled in a multicenter case-control study entitled "Retrospective study of laparoscopic colorectal surgery for elderly patients" that was conducted in Japan between 2003 and 2007, background characteristics and short-term and long-term outcomes for open surgery and laparoscopic surgery were compared.Results: Of the 398 patients included, 295 underwent open surgery and 103 underwent laparoscopic surgery. There were no significant differences in the baseline characteristics between open surgery and laparoscopic surgery patients, except for previous abdominal surgery and TNM stage. The median operation duration was shorter with open surgery (open surgery, 153 min; laparoscopic surgery, 202 min; P < 0.001), and less blood loss occurred with laparoscopic surgery (median open surgery, 109 g; median laparoscopic surgery, 30 g; P < 0.001). An operation duration of 180 min or more (odds ratio, 1.97; 95 % confidence interval, 1.17-3.37; P = 0.011) and selection of laparoscopic surgery (odds ratio, 0.41; 95 % confidence interval, 0.22-0.75; P = 0.003) were statistically significant in the multivariate analysis for postoperative morbidity. Moreover, laparoscopic surgery did not result in an inferior overall survival rate compared with open surgery (log-rank test P = 0.289, 0.278, 0.346, 0.199, for all-stage, stage 0-I, stage II, and stage III disease, respectively).Conclusions: Laparoscopic surgery in elderly colorectal cancer patients with a poor performance status is safe and not inferior to open surgery in terms of overall survival. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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