Background: Concerns about prolonged postoperative recovery may detract surgeons from offering colectomy to patients older than 80 years. The adoption of a minimally invasive approach may help to counter these beliefs, but concerns remain as to whether these patients can tolerate a pneumoperitoneum. This study compared outcomes after laparoscopic colectomy (LC) and open colectomy (OC) for patients older than 80 years.
Methods: From a prospectively maintained database, 97 patients undergoing elective LC between 1994 and 2008 were identified and matched 1:1 to OC patients for age, gender, year of surgery, extent of resection, proximal diversion, American Society of Anesthesiology score, and body mass index. Short-term outcomes including postoperative mortality, morbidity, and discharge status were assessed.
Results: The LC and OC patients were similar for the matched characteristics. Their mean age was 82.8 years (range, 80-94 years). The conversion rate for the LC patients was 14.4%. The OC group had a higher proportion of cancer patients (93.8% vs. 59.8%; P = 0.001). The discharge status for the LC and OC patients was similar, and most patients were discharged home without assistance (63.9% vs. 62.9%; P = 0.88). The median hospital stay was significantly shorter for LC (6 days; range, 1-67 days) than for OC (7 days; range, 2-53 days; P = 0.001). The 30-day postoperative complications (OC, 43.3% vs. LC, 37.1%; P = 0.38), reoperations (OC, 5.2% vs. LC, 4.1%; P = 0.73), and readmissions (OC, 6.2% vs. LC, 9.3%; P = 0.41) were similar. The overall mortality rate was 5.2% and similar between the two groups.
Conclusion: Complications and other outcomes are similar for LC and OC, and the earlier recovery associated with LC, as evidenced by a shorter hospital stay, may encourage a wider adoption of LC for patients older than 80 years.