MINIMALLY-INVASIVE SURGERY FOR COLLORECTAL CANCER IN ELDERLY PATIENTS

Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were presented. Out of them, 66 patients underwent laparatomy and 40 patients underwent laparoscopy. Patients were matched for ASA and CR-PОSSUM scales, age-and body mass index, dis- ease stage and type of surgery. Results. The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min). Intraoperative blood loss was higher in patients treated by laparotomy than by laparoscopy (167 ml versus 109 ml), but the differences were insignificant (р=0.36). No differences in lymphodissection quality and adequate resection volume between the groups were found. The average hospital stay was not significantly shorter in the laparoscopic group (р=0.43). Complications occurred with equal frequency in both groups (13.6 % compared to 15.0 %). The median follow-up time was 16 months (range, 6-30 months). The number of patients died during a long-term follow-up was 2 times higher after laparotomic surgery than after laparoscopic surgery, however, the difference was not statistically significant. Conclusion. Postoperative compli- cations in elderly patients with colorectal cancer did not exceed the average rates and did not depend on the age. Both groups were matched for the intraoperative bleeding volume and quality of lymphodenectomy. Significantly shorter duration of laparoscopic surgery was explained by the faster surgical access however, it showed no benefit in reducing the average length of hospital stay and decreasing the number of complications. The choice of surgi- cal access had no impact on life quality of patients after treatment. There was a tendency toward an increase in the percentage of deaths in a long-term follow-up due to causes not related to colorectal cancer, thus, resulting in the decreased overall survival rate in elderly patients treated by laparatomy.

colorectal cancer, elderly patients, surgical treatment, laparoscopic surgery

1. Baranov D.V., Krapivin B.V, Fisun A.M. Application of lifting techniques perform laparoscopic cholecystectomy in the treatment of gallstone disease in patients with middle and old age // Jendoskopicheskaja hirurgija. 1999. № 2. P. 8. [in Russian]

2. Glushkov N.I., Kubachev K.G., Lisicyn A.A. Small gas laparoscopic cholecystectomy as the operation of choice in the treatment of gallstone disease in patients at risk // Jendoskopicheskaja hirurgija. 1999. № 2. P. 18. [in Russian]

3. Likhvantsev V.V., Ilyin Yu.V., Shmeleva E.A., Danilov M.P., Skripkin Yu. V., Grebenchikov O.A. Consciousness Disorders of in Patients with Cerebrovascular Insufficiency after Elective Surgery // Obshhaja reanimatologija. 2015. № 1. P. 39–53. [in Russian]

4. Markar’jan D.V., Nikoda V.V., Car’kov P.V. Multidisciplinary approach in the perioperative management of patients with colorectal cancer elderly (review) // Rossijskij zhurnal gastrojenterologii, gepatologii, koloproktologii. 2011. № 1. P. 50–56. [in Russian]

5. Sapanjuk A.I., Buharin A.I., Kuklova I.I., Mamedov S.H., Hachatrjan D.V. Predicting of the hemodynamic response during laparoscopic cholecystectomy // Jendoskopicheskaja hirurgija. 2006. Vol. 12 (2). P. 119–120. [in Russian

6. Ahmed S., Howel D., Debrah S. The influence of age on the outcome of treatment of elderly patients with colorectal cancer // J. Geriatr. Oncol. 2014. Vol. 5 (2). P. 133–140. doi: 10.1016/j.jgo.2013.12.005.

7. Audisio R.A., Ramesh H., Longo W.E., Zbar A.P., Pope D. Preoperative assessment of surgical risk in oncogeriatric patients // Oncologist. 2005. Vol. 10 (4). P. 262–268.

8. Bojer A.S., Roikjar O. Elderly patients with colorectal cancer are oncologically undertreated // Eur. J. Surg. Oncol. 2015. Vol. 41 (3). P. 421–425. doi: 10.1016/j.ejso.2014.10.065.

9. Bretagnol F., Dedieu A., Zappa M., Guedj N., Ferron M., Panis Y. T4 colorectal cancer: is laparoscopic resection contraindicated? // Colorectal Dis. 2011. Vol. 13 (2). P. 138–143. doi: 10.1111/j.1463-1318 .2010.02380.x.

10. Cheatham M.L., White M.W., Sagraves S.G., Johnson J.L., Block E.F. Abdominal perfusion pressure: a superior parameter in the assessment of intraabdominal hypertension // J. Trauma. 2000. Vol. 49 (4). P. 621–626.

11. Cheema F.N., Abraham N.S., Berger D.H., Albo D., Taffet G.E. Naik A.D. Novel approaches to perioperative assessment and intervention may improve long-term outcomes after colorectal cancer resection in older adults // Ann. Surg. 2011. Vol. 253 (5). Р. 867–874. doi: 10.1097/SLA.0b013e318208faf0.

12. Christensen K., Doblhammer G., Rau R., Vaupel J.W. Ageing populations: the challenges ahead // Lancet. 2009. Vol. 374 (9696). P. 1196–1208. doi: 10.1016/S0140-6736(09)61460-4.

13. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer // New Engl. J. Med. 2004. Vol. 350 (20). P. 2050–2059.

14. Dahaba A.A., Rehak P.H., List W.F. A compare youngand elderly adult patients // Eur. J. Anaesthesiol. 1996. Vol. 13. P. 43–48.

15. Demongeot J. Biological boundaries and biological age // Acta Biotheor. 2009. Vol. 57 (4). P. 397–418. doi: 10.1007/s10441-009-9087-8.

16. Egenvall M., Schubert Samuelsson K., Klarin I., Lökk J., Sjövall A., Martling A., Gunnarsson U. Management of colorectal cancer in the elderly: a population – based study // Colorectal Dis. 2014. Vol. 16 (6). P. 433–441. doi: 10.1111/codi.12575.

17. Elnahas A., Sunil S., Jackson T.D., Okrainec A., Quereshy F.A. Laparoscopic versus open surgery for T4 colon cancer: evaluation of margin status. Surg Endosc. 2016. Vol. 30 (4). P. 1491–1496. doi: 10.1007/ s00464-015-4360-1.

18. Faivre J., Lemmens V.E., Quipourt V., Bouvier A.M. Management and survival of colorectal cancer in the elderly in population-based studies // Eur. J. Cancer. 2007. Vol. 43 (15). P. 2279–2284.

19. Frasson M., Braga M., Vignali A., Zuliani W., Di Carlo V. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients // Dis. Colon Rectum. 2008. Vol. 51 (3). Р. 296–300.

20. Fujii S., Ishibe A., Ota M., Yamagishi S., Watanabe K., Watanabe J., Kanazawa A., Ichikawa Y., Oba M., Morita S., Hashiguchi Y., Kunisaki C., Endo I. Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients // Surg. Endosc. 2014. Vol. 28 (2). Р. 466–476.

21. globocan.iarc.fr

22. Green B., Marshall H., Collinson F., Quirke P., Quirke P., Guillou P., Jayne D.G., Brown J.M. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer // Br. J. Surg. 2013. Vol. 100 (1). P. 75–82. doi: 10.1002/bjs.8945.

23. Grone J., Kreis M.E. Personalized treatment of colorectal cancer in old age // Chirurg. 2013. Vol. 84 (4). Р. 305–309. doi: 10.1007/s00104-012-2452-1.

24. Hinoi T., Kawaguchi Y., Hattori M., Okajima M., Ohdan H., Yamamoto S., Hasegawa H., Horie H., Murata K., Yamaguchi S., Sugihara K., Watanabe M. Japan Society of Laparoscopic Colorectal Surgery. Laparoscopic versus open surgery for colorectal cancer in elderly patients: a multicenter matched case-control study // Ann. Surg. Oncol. 2015. Vol. 22 (6). Р. 2040–2050. doi: 10.1245/s10434-014-4172-x.

25. Hopkins D., Gemmell L.W. Intraabdominal hypertension and the abdominal compartment syndrome // BSA - CEPD Reviews. 2001. № 2. P. 56–58.

26. Inoue Y., Kawamoto A., Okugawa Y., Hiro J., Saigusa S., Toiyama Y., Araki T., Tanaka K., Mohri Y., Kusunoki M. Efficacy and safety of laparoscopic surgery in elderly patients with colorectal cancer // Mol. Clin. Oncol. 2015. Vol. 3 (4). Р. 897–901.

27. Jeong S., Park J., Nam B., Kim S., Kang S.B., Lim S.B., Choi H.S., Kim D.W., Chang H.J., Kim D.Y., Jung K.H., Kim T.Y., Kang G.H., Chie E.K., Kim S.Y., Sohn D.K., Kim D.H., Kim J.S., Lee H.S., Kim J.H., Oh J.H. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant hemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial // Lancet Oncol. 2014. Vol. 15 (7). P. 767–74. doi: 10.1016/S1470-2045(14)70205-0.

28. Jin L., Inoue N., Sato N., Matsumoto S., Kanno H., Hashimoto Y., Tasaki K., Sato K., Sato S., Kaneko K. Comparison between surgical outcomes of colorectal cancer in younger and elderly patients // World J. Gastroenterol. 2011. Vol. 17 (12). P. 1642–1648. doi: 10.3748/wjg. v17.i12.1642.

29. Kruschewski M., Germer C.T., Rieger H., Buhr H.J. Radical resection of colorectal carcinoma in the oldest old // Chirurg. 2002. Vol. 73 (3). Р. 241–244.

30. Malbrain M.L. Deeren D., De Potter T.J. Abdominal pressure in the critically ill // Curr. Opinion Crit. Care. 2005. Vol. 11 (2). P. 156–171.

31. Nitsche U., Späth C., Müller T.C., Maak M., Janssen K.P., Wilhelm D., Kleeff J., Bader F.G. Colorectal cancer surgery remains effective with rising patient age // Int. J. Colorectal Dis. 2014. Vol. 29 (8). P. 971–979. doi: 10.1007/s00384-014-1914-y.

32. Ohigashi S. Present state and problems for colorectal cancer in elderly patients // Nihon Rinsho. 2014. Vol. 72 (1). P. 134–138.

33. Schiffmann L., Ozcan S., Schwarz F., Lange J., Prall F., Klar E. Colorectal cancer in the elderly: surgical treatment and long-term survival// Int. J. Colorectal Dis. 2008. Vol. 23 (6). P. 601–610. doi: 10.1007/s00384-008-0457-5.

34. Schiphorst A.H., Verweij N.M., Pronk A., Borel Rinkes I.H., Hamaker M.E. Non-surgical complications after laparoscopic and open surgery for colorectal cancer - A systematic review of randomised controlled trials // Eur. J. Surg. Oncol. 2015. Vol. 41 (9). Р. 1118–1127. doi:10.1016/j.ejso.2015.04.007.

35. Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group // Lancet. 2000. Vol. 356 (9234). P. 968–974.

36. Torre C., Paliogiannis P., Pulighe F., Scognamillo F., Castiglia P., Trignano M. Impact of age on the quality of lymphadenectomy for colorectal cancer // Cancer Invest. 2013. Vol. 31 (1). P. 39–42. doi:10.3109/07357907.2012.749266.

37. Veldkamp R., Kuhry E., Hop W.C., Jeekel J., Kazemier G., Bonjer H.J., Haglind E., Påhlman L., Cuesta M.A., Msika S., Morino M., Lacy A.M. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial // Lancet Oncology. 2005. Vol. 6 (7). P.477–484.

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