Published online Jul 15, 2016. doi: 10.4251/wjgo.v8.i7.573
Peer-review started: March 7, 2016
First decision: April 15, 2016
Revised: April 15, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: July 15, 2016
AIM: To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients.
METHODS: A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared laparoscopic colectomy (LAC) in elderly colorectal cancer patients with open colectomy (OC) were retrieved, and their short and long-term outcomes compared. Elderly people were defined as 65 years old or more. Inclusion criteria were set at: Resection of colorectal cancer, comparison between laparoscopic and OC and no significant difference in backgrounds between groups.
RESULTS: Fifteen studies were identified for analysis. LAC was performed on 1436 patients, and OC performed on 1810 patients. In analyses of short-term outcomes, operation time for LAC was longer than for OC (mean difference = 34.4162, 95%CI: 17.8473-50.9851, P < 0.0001). The following clinical parameters were lower in LAC than in OC: Amount of estimated blood loss (mean difference = -93.3738, 95%CI: -132.3437 to -54.4039, P < 0.0001), overall morbidity (OR = 0.5427, 95%CI: 0.4425-0.6655, P < 0.0001), incisional surgical site infection (OR = 0.6262, 95%CI: 0.4310-0.9097, P = 0.0140), bowel obstruction and ileus (OR = 0.6248, 95%CI: 0.4519-0.8638, P = 0.0044) and cardiovascular complications (OR = 0.4767, 95%CI: 0.2805-0.8101, P = 0.0062). In analyses of long-term outcomes (median follow-up period: 36.4 mo in LAC, 34.3 mo in OC), there was no significant difference in overall survival (mean difference = 0.8321, 95%CI: 0.5331-1.2990, P = 0.4187) and disease specific survival (mean difference = 1.0254, 95%CI: 0.6707-1.5675, P = 0.9209). There was also no significant difference in the number of dissected lymph nodes (mean difference = -0.1360, 95%CI: -4.0553-3.7833, P = 0.9458).
CONCLUSION: LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC were similar to that of OC. These results support the assertion that LAC is an effective procedure for elderly patients with colorectal cancer.
Core tip: Safety and effectiveness of laparoscopic surgery (LAC) in elderly has been unknown. A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared LAC in elderly colorectal cancer patients with open colectomy (OC) were retrieved, and their short and long-term outcomes compared. Fifteen studies which had 1436 LAC and 1810 OC were identified. In short-term outcomes, blood loss, morbidity, incisional surgical site infection, bowel obstruction and cardiovascular complications were superior in LAC except operation time. There was no significant difference in long-term outcomes. LAC is an effective procedure for elderly with colorectal cancer.