PERI-OPERATIVE OUTCOMES IN ELDERLY UNDERGOING MINIMALLY INVASIVE RIGHT HEMICOLECTOMY
EAES Academy. Ortenzi M. 07/05/22; 363012; P055
Dr. Monica Ortenzi
Contributions
Contributions
Abstract
Aims:
Several studies demonstrate the advantages of minimally invasive colonic resections in improving short-term postoperative outcomes. However, currently, the treatment strategy for elderly patients depends on the policies of each institution. The aim of this study was to investigate the safety and feasibility of minimally invasive right hemicolectomy for patients with colon cancer aged over 75 years using a propensity score matching (PSM) model based on age and Charlson Comorbidity Index (CCI).
Materials: This was a multicenter retrospective study combining four prospectively maintained databases of consecutive patients undergoing elective right hemicolectomy between January 2013 and December 2020. The primary endpoint of the study was to analyse the short-term postoperative results of minimally invasive right hemicolectomy in elderly patients. Secondary outcomes included risk factors for complications and prolonged operative time. Patients were divided into three groups according to their age: Group I (control group, < 60 years), Group II (>60-75), Group III (≧75), and further divided according to the operative approach: Laparoscopic (LrH) or Robotic (RrH) and Open resection (OrH). Variables baseline demographic data (gender, Body Mass Index(BMI), American Society of Anaestesiologists (ASA) grade, Charlson Comorbidity Index (CCI), comorbidities, Previous abdominal surgery, CT location, size and stage of the tumour), intra-operative data (operative time, intra-operative complications, need and causes of conversion) and post-operative course (post-operative complications, time to flatus and length of stay) were investigated. Need for readmission and 90-days mortality were also included.
Results Of the 618 included patients, 267 (43.2%) were aged between 60 and 75 years, while 268 (43.4 %) were older than 75 years, 337 (54.5) patients LrH, 144 (23.3%) RrH and 137 (22.2%) OrH. Group II and III did not differ for short term major surgical complications rate (p=0.392), nor for general major complications (13 Vs 8; p=0.380), nor in the length of hospital stay and readmission rate (p=0.944 and p= 0.308 respectively). None of the post-operative parameters analyzed differed when comparing LrH and RrH. Mortality was not observed. OrH statistically differed from LrH/RrH in intraoperative complications (6 vs 1; p=0.011) and estimated intra-operative blood loss (p=0.001) was observed. The rate of post-operative complications was significantly higher in the OrH group (40 vs 82; p=0.22) considering both surgical and general complications (p= 0.039 and p<0.0001, respectively). Mortality at 90 days from the operation was observed in 5 patients (3.8%) in the OrH group. Male gender and tumour location were identified as risk factors for prolonged operative time at univariate analysis but not in the multivariate analysis. Open procedures were associated with operative time >180 min in both univariate and multivariate analysis. Conversion to open surgery resulted as a risk factor for complication occurrence and Class III complications in both univariate and multivariate analyses. Open procedure was a risk factor for Class III only at univariate analysis.
Conclusions:
These results suggest that indication for laparoscopic surgery should not be abandoned for elderly patients solely based on older age. The decision should be taken based on the individual patient condition, life expectancy, and patient’s wishes and not specifically based on patient age
Several studies demonstrate the advantages of minimally invasive colonic resections in improving short-term postoperative outcomes. However, currently, the treatment strategy for elderly patients depends on the policies of each institution. The aim of this study was to investigate the safety and feasibility of minimally invasive right hemicolectomy for patients with colon cancer aged over 75 years using a propensity score matching (PSM) model based on age and Charlson Comorbidity Index (CCI).
Materials: This was a multicenter retrospective study combining four prospectively maintained databases of consecutive patients undergoing elective right hemicolectomy between January 2013 and December 2020. The primary endpoint of the study was to analyse the short-term postoperative results of minimally invasive right hemicolectomy in elderly patients. Secondary outcomes included risk factors for complications and prolonged operative time. Patients were divided into three groups according to their age: Group I (control group, < 60 years), Group II (>60-75), Group III (≧75), and further divided according to the operative approach: Laparoscopic (LrH) or Robotic (RrH) and Open resection (OrH). Variables baseline demographic data (gender, Body Mass Index(BMI), American Society of Anaestesiologists (ASA) grade, Charlson Comorbidity Index (CCI), comorbidities, Previous abdominal surgery, CT location, size and stage of the tumour), intra-operative data (operative time, intra-operative complications, need and causes of conversion) and post-operative course (post-operative complications, time to flatus and length of stay) were investigated. Need for readmission and 90-days mortality were also included.
Results Of the 618 included patients, 267 (43.2%) were aged between 60 and 75 years, while 268 (43.4 %) were older than 75 years, 337 (54.5) patients LrH, 144 (23.3%) RrH and 137 (22.2%) OrH. Group II and III did not differ for short term major surgical complications rate (p=0.392), nor for general major complications (13 Vs 8; p=0.380), nor in the length of hospital stay and readmission rate (p=0.944 and p= 0.308 respectively). None of the post-operative parameters analyzed differed when comparing LrH and RrH. Mortality was not observed. OrH statistically differed from LrH/RrH in intraoperative complications (6 vs 1; p=0.011) and estimated intra-operative blood loss (p=0.001) was observed. The rate of post-operative complications was significantly higher in the OrH group (40 vs 82; p=0.22) considering both surgical and general complications (p= 0.039 and p<0.0001, respectively). Mortality at 90 days from the operation was observed in 5 patients (3.8%) in the OrH group. Male gender and tumour location were identified as risk factors for prolonged operative time at univariate analysis but not in the multivariate analysis. Open procedures were associated with operative time >180 min in both univariate and multivariate analysis. Conversion to open surgery resulted as a risk factor for complication occurrence and Class III complications in both univariate and multivariate analyses. Open procedure was a risk factor for Class III only at univariate analysis.
Conclusions:
These results suggest that indication for laparoscopic surgery should not be abandoned for elderly patients solely based on older age. The decision should be taken based on the individual patient condition, life expectancy, and patient’s wishes and not specifically based on patient age
Aims:
Several studies demonstrate the advantages of minimally invasive colonic resections in improving short-term postoperative outcomes. However, currently, the treatment strategy for elderly patients depends on the policies of each institution. The aim of this study was to investigate the safety and feasibility of minimally invasive right hemicolectomy for patients with colon cancer aged over 75 years using a propensity score matching (PSM) model based on age and Charlson Comorbidity Index (CCI).
Materials: This was a multicenter retrospective study combining four prospectively maintained databases of consecutive patients undergoing elective right hemicolectomy between January 2013 and December 2020. The primary endpoint of the study was to analyse the short-term postoperative results of minimally invasive right hemicolectomy in elderly patients. Secondary outcomes included risk factors for complications and prolonged operative time. Patients were divided into three groups according to their age: Group I (control group, < 60 years), Group II (>60-75), Group III (≧75), and further divided according to the operative approach: Laparoscopic (LrH) or Robotic (RrH) and Open resection (OrH). Variables baseline demographic data (gender, Body Mass Index(BMI), American Society of Anaestesiologists (ASA) grade, Charlson Comorbidity Index (CCI), comorbidities, Previous abdominal surgery, CT location, size and stage of the tumour), intra-operative data (operative time, intra-operative complications, need and causes of conversion) and post-operative course (post-operative complications, time to flatus and length of stay) were investigated. Need for readmission and 90-days mortality were also included.
Results Of the 618 included patients, 267 (43.2%) were aged between 60 and 75 years, while 268 (43.4 %) were older than 75 years, 337 (54.5) patients LrH, 144 (23.3%) RrH and 137 (22.2%) OrH. Group II and III did not differ for short term major surgical complications rate (p=0.392), nor for general major complications (13 Vs 8; p=0.380), nor in the length of hospital stay and readmission rate (p=0.944 and p= 0.308 respectively). None of the post-operative parameters analyzed differed when comparing LrH and RrH. Mortality was not observed. OrH statistically differed from LrH/RrH in intraoperative complications (6 vs 1; p=0.011) and estimated intra-operative blood loss (p=0.001) was observed. The rate of post-operative complications was significantly higher in the OrH group (40 vs 82; p=0.22) considering both surgical and general complications (p= 0.039 and p<0.0001, respectively). Mortality at 90 days from the operation was observed in 5 patients (3.8%) in the OrH group. Male gender and tumour location were identified as risk factors for prolonged operative time at univariate analysis but not in the multivariate analysis. Open procedures were associated with operative time >180 min in both univariate and multivariate analysis. Conversion to open surgery resulted as a risk factor for complication occurrence and Class III complications in both univariate and multivariate analyses. Open procedure was a risk factor for Class III only at univariate analysis.
Conclusions:
These results suggest that indication for laparoscopic surgery should not be abandoned for elderly patients solely based on older age. The decision should be taken based on the individual patient condition, life expectancy, and patient’s wishes and not specifically based on patient age
Several studies demonstrate the advantages of minimally invasive colonic resections in improving short-term postoperative outcomes. However, currently, the treatment strategy for elderly patients depends on the policies of each institution. The aim of this study was to investigate the safety and feasibility of minimally invasive right hemicolectomy for patients with colon cancer aged over 75 years using a propensity score matching (PSM) model based on age and Charlson Comorbidity Index (CCI).
Materials: This was a multicenter retrospective study combining four prospectively maintained databases of consecutive patients undergoing elective right hemicolectomy between January 2013 and December 2020. The primary endpoint of the study was to analyse the short-term postoperative results of minimally invasive right hemicolectomy in elderly patients. Secondary outcomes included risk factors for complications and prolonged operative time. Patients were divided into three groups according to their age: Group I (control group, < 60 years), Group II (>60-75), Group III (≧75), and further divided according to the operative approach: Laparoscopic (LrH) or Robotic (RrH) and Open resection (OrH). Variables baseline demographic data (gender, Body Mass Index(BMI), American Society of Anaestesiologists (ASA) grade, Charlson Comorbidity Index (CCI), comorbidities, Previous abdominal surgery, CT location, size and stage of the tumour), intra-operative data (operative time, intra-operative complications, need and causes of conversion) and post-operative course (post-operative complications, time to flatus and length of stay) were investigated. Need for readmission and 90-days mortality were also included.
Results Of the 618 included patients, 267 (43.2%) were aged between 60 and 75 years, while 268 (43.4 %) were older than 75 years, 337 (54.5) patients LrH, 144 (23.3%) RrH and 137 (22.2%) OrH. Group II and III did not differ for short term major surgical complications rate (p=0.392), nor for general major complications (13 Vs 8; p=0.380), nor in the length of hospital stay and readmission rate (p=0.944 and p= 0.308 respectively). None of the post-operative parameters analyzed differed when comparing LrH and RrH. Mortality was not observed. OrH statistically differed from LrH/RrH in intraoperative complications (6 vs 1; p=0.011) and estimated intra-operative blood loss (p=0.001) was observed. The rate of post-operative complications was significantly higher in the OrH group (40 vs 82; p=0.22) considering both surgical and general complications (p= 0.039 and p<0.0001, respectively). Mortality at 90 days from the operation was observed in 5 patients (3.8%) in the OrH group. Male gender and tumour location were identified as risk factors for prolonged operative time at univariate analysis but not in the multivariate analysis. Open procedures were associated with operative time >180 min in both univariate and multivariate analysis. Conversion to open surgery resulted as a risk factor for complication occurrence and Class III complications in both univariate and multivariate analyses. Open procedure was a risk factor for Class III only at univariate analysis.
Conclusions:
These results suggest that indication for laparoscopic surgery should not be abandoned for elderly patients solely based on older age. The decision should be taken based on the individual patient condition, life expectancy, and patient’s wishes and not specifically based on patient age
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