Short-term outcomes of laparoscopic colorectal cancer surgery in elderly patients. -Is it really safe in elderly patients with severe comorbidities?-

Introduction: We aimed to assess the safety and validity of laparoscopic colorectal surgery (LCS) in elderly patients focusing on severe postoperative complications.In addition, we compared multiple preoperative risk scoring tools to identify the optimal tool for predicting postoperative complications. Methods: Medical records of 493 patients who underwent LCS or open colorectal surgery (OCS) were retrospectively reviewed and they were divided into four groups based on their age and procedure: group E/LCS (age >= 80 years and LCS), group Y/LCS (age < 80 years and LCS), group E/OCS (age >= 80 years and OCS), and group Y/OCS (age < 80 years and OCS). Preoperative characteristics and postoperative outcomes were analyzed. Furthermore, patients were divided into two groups based on the incidence of postoperative complication. Physiological score and Operative severity score from POSSUM, Physiological score and Operative severity score from CR-POSSUM, Preoperative risk score, Surgical stress score, and comprehensive risk score from E-PASS, SAS, and PNI were compared. Results: The incidence of postoperative complications was significantly lower in group E/LCS than in groups E/OCS and Y/OCS. Respiratory and cardiovascular complications were not observed in E/LCS, even though patients had severe cardiovascular comorbidities. Regarding the comparison of risk scoring tools, all of the risk scoring tools did not differ between two groups except SSS. Conclusion: There is a possibility that the severity of heart failure does not affect postoperative complications in LCS. Regarding risk scoring tools, there was no suitable preoperative risk scoring tool which gives an advice on if we can perform LCS safely. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of Surgical Associates Ltd.