Short-Term Outcomes of Laparoscopic Surgery Compared to Open Surgery for Large (≥ 5 cm) Colonic Adenocarcinomas in Patients Aged More Than 75 Years

Abstract

Background

We compared short-term outcomes of laparoscopic surgery and open surgery (OS) for older patients with large (≧ 5 cm) colonic adenocarcinomas.

Methods

Patients ≥ 75 years with stage I-III colon cancer were identified in the NCDB (2010-2020). Patients were divided into laparoscopic or OS groups and propensity-score matched, and outcomes were compared. Primary outcomes were 30- and 90-day mortality and secondary outcomes were hospital stay, positive resection margins, and harvested lymph node number.

Results

15,253 patients were included (MIS = 5860; OS = 8486), with 5672 in each group after matching. 68.2% of cancers were right-sided. Laparoscopic surgery was associated with lower 30-day (OR: 0.56, 95% CI: 0.47, 0.66; P < 0.001) and 90-day mortality rates (OR: 0.58, 95% CI: 0.51, 0.66; P < 0.001) compared to OS. Laparoscopic surgery was significantly associated with lower 30- and 90-day mortality and shorter hospital stays for all tumor locations. Laparosscopic surgery for right-sided tumors was more often associated with negative resection margins (94.4% vs 92.8%; P = 0.005), and shorter hospital stays (5.0 [4.0-7.0] vs 6.0 [5.0-9.0] days; P < 0.001). Laparoscopic surgery was associated with more harvested lymph nodes in right colon cancers (median: 20.0 [15.0-26.0] vs 19.0 [15.0-25.0]; P < 0.001) and left colon cancers (18.0 [14.0-23.0] vs 17.0 [13.0-23.0]; P = 0.001) cancers, but not in transverse colon cancers (18.0 [14.0-25.0] vs 19.0 [14.0-25.0]; P = 0.518).

Conclusion

This study highlights the potential for laparoscopic surgery in elderly patients with large colonic adenocarcinomas. Findings were consistent when stratified by tumor location, except transverse colon cancers where resection quality was comparable to OS.