Laparoscopic vs open colorectal cancer surgery in elderly patients: short- and long-term outcomes and predictors for overall and disease-free survival

Abstract

Background: Colorectal cancer is common in elderly patients. Laparoscopy is widely used to approach this kind of disease. This study was to examine short-term outcomes and long-term survival for laparoscopic and open surgery in elderly patients with colorectal cancer.

Methods: From January 2007 to December 2018, patients with colorectal cancer older than 80 operated at China National Cancer Center were included in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between open and laparoscopic surgery was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed by Cox proportional hazard model.

Results: Ninety-three pairs were selected after PSM. Patients in laparoscopic group had less intraoperative blood loss, postoperative complications, time to first flatus, time to oral feeding, postoperative hospital stay, and higher retrieved lymph node (P < 0.05). The OS and DFS rates were similar (P > 0.05), besides the CEA level, III/IV stage, and perineural invasion were independent predictors of survival (P < 0.05).

Conclusion: In elderly patients with colorectal cancer, laparoscopic surgery had better short-term outcomes than open surgery. CEA level, III/IV stage, and perineural invasion were reliable predictors for OS and DFS.

Keywords: Colorectal cancer; Elderly patients; Laparoscopic surgery; Open surgery; Surgical outcomes.

Fig. 1

Overall Survival curve in matched cohort of laparoscopic and open groups. In the matched cohort, in the laparoscopic group, 3- year and 5-year Overall survival rates were 83.9 and 73.1% respectively and they were 79.6 and 63.4% respectively in the open group. There was no significant difference between the laparoscopic and open groups (P = 0.224)

Fig. 2

Disease-free curve in matched cohort of laparoscopic and open group. In the matched cohort, in the laparoscopic group, 3- year and 5-year disease-free survival rates were 76.3 and 69.9% respectively and they were 66.6 and 53.8% respectively in the open group. There was no significant difference between the laparoscopic and open groups (P = 0.230)