Morbidity after laparoscopic and open rectal cancer surgery: a comparative analysis of morbidity in octogenarians and younger patients.
AIM
Although the oncological adequacy of laparoscopic rectal resection (LR) appears equivalent to open resection (OR), its benefit is controversial in the elderly. The aim of this study was to investigate the influence of LR on morbidity and mortality in octogenarians.


METHOD
This was a retrospective analysis of all patients who underwent rectal surgery for cancer between 2003 and 2013 in a teaching hospital. The primary aim of the study was to assess the influence of surgical approach on mortality and morbidity of rectal resection in patients ≥ 80 years old. Regression analysis was performed to control the effect of covariables on the clinical outcome.


RESULTS
Of 408 patients 203 were in the LR group and 205 in the OR group including 303 (74.3%) less than 80 years and 105 (25.7%) over 80 years. The mortality was lower in the LR group compared with the OR group for patients under 80 years (0% vs 4.6%; P = 0.049) and no different in the over 80 group (11.5% vs 9.4%; P = 0.859). In younger patients, the OR group showed longer hospital stay (9 vs 7 days; P < 0.001) and more complications (44.1% vs 29.8%; P = 0.042). Medical complications were more frequent in LR group than OR group octogenarians (40.4% vs 20.8%; P = 0.009) as well as grade C anastomotic leakage (13.8 vs 10.7; P = 0.041).


CONCLUSION
LR for rectal cancer showed clinical advantages in patients under 80 years and was as safe as OR in patients over 80 years, although the advantages of laparoscopic surgery were lost in the elderly group due to a higher rate of medical complications. OR may be an option in elderly patients with important comorbidities.
['Landi|F|F|http://orcid.org/0000-0002-8836-6466', 'Vallribera|F|F|', 'Rivera|J P|JP|', 'Bertoli|P|P|', 'Armengol|M|M|', 'Espín|E|E|']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D013505:Digestive System Surgical Procedures D005260:Female D006801:Humans D010535:Laparoscopy D008297:Male D009017:Morbidity D011183:Postoperative Complications D012004:Rectal Neoplasms D012189:Retrospective Studies D012307:Risk Factors D016896:Treatment Outcome
Rectal cancer surgery morbidity and mortality elderly patients laparoscopic versus open rectal surgery