Introduction Elderly patients are at increased risk of death following surgery for colorectal cancer, even in the elective setting. This national study aims to examine the relationship between patient selection for laparoscopic resection and survival in an elderly cohort.
Method Elderly patients (80 years and over) undergoing elective colorectal cancer resection between the years 2001–2011 were identified from the Hospital Episode Statistics (HES) database. Mortality data from Office for National Statistics (ONS) were obtained. Survival analyses using multivariable cox proportional hazard regression were carried. Confounding variables such as gender, medical comorbidity, type of operation and chemotherapy were adjusted for.
Results In the time period, 5,398 elderly patients underwent elective colorectal cancer resection, of which 1,479 patients (27.4%) underwent laparoscopic resection. The mean 5-year survival in the open group was 41.0 months (95% CI 40.3–41.7) in the open group compared with 52.3 months (95% CI 51.2–53.3) in the laparoscopic group (p < 0.001). Multivariable cox hazard regression, demonstrated laparoscopic resection to have a 61% survival benefit over open surgery in elderly patients (HR 0.39, CI 0.33–0.45, p < 0.001). This survival benefit persisted, even when adjusting for immediate (90-day) post-operative mortality (HR 0.40, CI 0.32–0.44, p < 0.001).
Conclusion Laparoscopic resections for colorectal cancer confer a survival advantage beyond the immediate post operative period in elderly patients. Offering this high-risk patient group elective laparoscopic resections in experienced units could help deliver better outcomes.
Disclosure of interest None Declared.
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