Laparoscopic colorectal surgery is safe and may be beneficial in patients eighty years of age and over

Abstract

Objective: To establish that the laparoscopic approach to colorectal resection is safe with regards to post- operative morbidity and mortality in patients eighty years of age and over. Methods: Prospectively collect- ed data for consecutive patients aged eighty years and older who underwent laparoscopic colorectal resec-tion by the same surgeon (Dr Daniel R. Kozman) from 1st January 2009 till 31st March 2011, were retrospectively analysed. Data collected included baseline demographic information, operative indication, American Society of Anaesthesiologists (ASA) grading, procedure type, length of procedure, post-operative course, length of hospital stay, dis-charge destination and complications. Results: Thirty-one patients underwent laparoscopic colectomy during the study period, 28 for adenocarcinoma. The median age was 85.5 (range 80 - 92) years, 15 patients were male and 25 patients were from home. The mean operating time was 118.4 minutes (range 45 - 271). Conversion was required in only 4 of 31 cases (13%). The mortality rate was 10% in total, and 0% in elective cases. Three patients required re-operation, 2 of which initially presented in the emergency setting and were subsequently deceased. For survivors, the length of hospital stay was 8.1 days (range 3 - 30) with 100% returning to original place of residence. Conclusion/ Interpretation: Laparoscopic surgery in patients eighty years and over is safe and may be beneficial in the elective setting. This is evident by low complication rate, fast return to bowel function, short length of hospital stay, and likely return to pre-operative place of residence and low mortality rate in elective patients. Careful consideration should be given to its use in an emergency setting.