Published online Oct 27, 2019. doi: 10.4240/wjgs.v11.i10.395
Peer-review started: April 19, 2019
First decision: August 2, 2019
Revised: October 14, 2019
Accepted: October 18, 2019
Article in press: October 18, 2019
Published online: October 27, 2019
There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.
To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol (ERP) after laparoscopic colorectal resection.
Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed. Three groups were considered according to patients’ age: Group A, 65 years old or less, Group B, 66 to 75 years old and Group C, 76 years old or more. Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications, mortality and readmission rate. Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.
Among the 225 patients, 112 belonged to Group A, 57 to Group B and 56 to Group C. Thirty-day overall morbidity was 32.9% whilst mortality was nihil. Though the percentage of complications progressively increased with age (25.9% vs 36.8% vs 42.9%), no differences were observed in the rate of major complications (4.5% vs 3.5% vs 1.8%), prolonged post-operative ileus (6.2% vs 12.2% vs 10.7%) and anastomotic leak (2.7% vs 1.8% vs 1.8%). Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal (P = 0.032) and autonomous deambulation (P = 0.013) in elderly patients. Although discharge criteria were achieved later in older patients (3 d vs 3 d vs 4 d, P = 0.040), post-operative length of stay was similar in the 3 groups (5 d vs 6 d vs 6 d).
ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.
Core tip: Feasibility and safety of enhanced recovery protocols in elderly populations undergoing minimally invasive colorectal surgery have been questioned by recent literature. Age has been considered an obstacle for enhanced recovery and a risk factor for surgical outcomes. Our study investigated the impact of age on fast-track after laparoscopic colorectal resection. Early removal of urinary catheter and walking resumption were the most difficult goals achieved by the elderly. Nevertheless, general compliance to fast-track items was good and, although discharge criteria were fulfilled later in older patients, no differences in length of stay and major complications rate were observed.