Morbidity after laparoscopic and open rectal cancer surgery: a comparative analysis of morbidity in octogenarians and younger patients
Menée à partir de données portant sur 408 patients atteints d'un cancer rectal traité entre 2003 et 2013, cette étude évalue, du point de vue des complications et de la mortalité, l'intérêt d'une résection laparoscopique et d'une intervention chirurgicale par voie ouverte en fonction de l'âge des patients (âge inférieur ou supérieur à 80 ans)
Aim : Although the oncological adequacy of laparoscopic rectal resection (LR) appears equivalent to open (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 this study was to assess the influence of surgical approach on mortality and morbidity of rectal resection in patient ≥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 for patients under 80 years compared with OR (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, 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 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.