Introduction With increasing life expectancy in the general population and changing attitudes to the provision of healthcare, an increasing number of octogenarians are offered surgical interventions. Recent advances in laparoscopic surgery and enhanced recovery protocols have enabled surgeons to offer colonic and rectal resection to the premorbid older patients more safely. The aim of this retrospective analysis is to determine the outcome and safety of performing colonic resections in the 80+ age group.
Method A retrospective analysis was carried out using Electronic notes, patient case notes and Web-V system for pathology for all the patients aged 80 or above, who underwent major colorectal surgery. The Clavien-Dindo classification was used to analyse surgical complications.
Results In total, 160 colonic resections were done by a single surgeon between May 2011–Jan 2015. 31 of these were aged 80 and above and were analysed further. The male to female ratio was 13:18, median age was 83, and the median duration of stay was 13 days. Median ASA grade was III.
Out of these, 6 had (19.4%) anterior resections, 14 (45.2%) had right hemi-colectomy, 3 (9.7%) had left and sigmoid colectomy; 4 (12.9%) had Hartmann’s resection and 4 (12.9%) had APER.
96.7% of the 31 resections were laparoscopic, with the only exception being a resection for recurrent colonic cancer. 10 patients (32.2%) had a permanent stoma, with 1 patient being given a temporary stoma which was subsequently reversed. Cancer classification for these cases were 19.4% (n = 6) Dukes’ A, 45.2% (n = 14) Dukes’ B and 29% (n = 9) Dukes’ C.
Analysis of surgical complications showed that 58% (n = 18) had normal course of recovery, 29% (n = 9) had Grade I and II complications, 2 patients had Grade III, and 2 patients had Grades IV and V complications. The patients with Grades IV and V, both suffered anastomotic leaks and were taken back to theatre; and subsequently died of multi-organ failure and sepsis. Five patients required post-operative blood transfusion. Pertinent to note in the total group of 160 resections, there were 4 anastomotic leaks and the two cases in the below 80 age group were managed with laparoscopic washout, with one case requiring a de-functioning stoma.
Conclusion Laparoscopic colonic resections can be safely performed in octogenarian group with none to moderate post op complications, however their ability to withstand a major post-op complications such as anastomotic leak is poor as evident by two deaths in the group. This risk should be discussed in greater depth during the informed consent process, and should there be any doubt, it should be worth considering a permanent stoma.
Disclosure of interest None Declared.
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