Studio prospettico multicentrico di efficacia della chirurgia laparoscopica colorettale per patologia neoplastica nel paziente grande anziano

Aim: to evaluate the effectiveness of laparoscopic surgery (LCS) for the treatment of colorectal cancer (CRC) in the very elderly over 80 years of age Methods: we performed a prospective multicentric analysis comparing patients over 80 yo and patients between 60 and 69 yo undergoing LCS for cancer from January 2008 to December 2013. We considered laparoscopic right colectomies, left colectomies, anterior rectal resections and other procedurel including segmental resections and Miles’ procedures. Colon and rectal cancers were analyzed separately. Preoperative workup, surgical techniques and instruments, peri-operative cares were standardized. Data on the patients’ demographics, disease features, operative details and short-term follow up were recorded and analyzed through an appropriate statistical comparison. Comorbidity and complications were classified using the Charlson Comorbidity index (CCI) and the Clavien Dindo classification system (CDCS) respectively. Oncological parameters included tumor-free resection margins, number of lymph nodes harvested and circumferential resection margin. Results: Group A included 96 and 33 patients, Group B 220 and 82 for colon and rectal cancers respectively. Groups were similar except for ASA score and CCI, as expected. We recorded a significant number of colonic in situ tumors Group B (0 vs 6.4%) and rectal T2 tumors (18.2 vs 39.0%) in Group B, a greater number of rectal T3 tumors (60.6 vs 26.8%) in Group A. There was no significant difference in operative time [Colon; Rectum] (178,0 ± 42,0 vs 185,3 ± 43,2 min; NS - 190,3 ± 52,5 vs 201,4 ± 54,9 min; NS), estimated blood loss (59,9 ± 51,8 vs 63,3 ± 60,1 mL; NS - 78,3 ± 81,9 vs 61,0 ± 55,6 mL; NS) and conversion rate (2,1 vs 2,7%; NS – 3,0 vs 2,4%; NS). Timing of first stool (3,1 ± 1,3 vs 3,5 ± 1,8 gg; NS - 3,3 ± 1,2 vs 3,3 ± 1,7 gg; NS), length of hospital stay (7,4 ± 2,1 vs 7,2 ± 2,1 gg; NS - 8,5 ± 1,7 vs 8,5 ± 2,8 gg; NS) and 30 days readmission rate (1,0 vs 0,45%; NS – 6,1 vs 1,2%; NS) were similar. Tumour-free margins were appropriate and positivity of CRM is poor (6.1 vs 4.9; NS). We didn’t record statistically significant differences in CDCS complications rate (47,9 vs 43,6%; NS – 63,6 vs 52,4%; NS). Conclusions: Laparoscopic surgery is effective for the treatment of colorectal cancer even in the very elderly. Age is not a risk factor or a limitation for LCS.