Laparoscopic and open approach in elderly patients with colon or rectal cancer 

The appropriate approach to surgical intervention in the elderly population which is in constant increase  is a major issue. Minimally invasive approach which has been proven to reduce cardiopulmonary stress and hospitalization should be the ideal choice in elderly patients. When laparoscopic and open approach are compared in a large series including 122 patients with colon or rectal cancer aged eighty years or older, laparoscopy approach resulted to be a  safe option  with  a trend to a lower complication rate (21.3 % LPS  vs 31.1% in open %) and similar mortality rate. Moreover these findings support the hypothesis that age per se in the absence of significant disease should be not considered a prognostic factor in gastrointestinal surgery.   In the laparoscopic colectomy group a shorter length of stay was observed which should be a reflection of the earlier recovery of bowel function (p = 0.01) , or to the better recovery of full independence (p = 0.02) . The significant lower need for hospital care  and the shorter hospital stay observed in the laparoscopic group represented a tremendous advantage for elderly patients to reduce  the risk for nosocomial complications. Moreover a significant lower need for post-hospital nursing deserves major consideration, because of quality of life and financial implications.

Bibliographical reference:

Vignali A, Di Palo S, Tamburini A, Radeaelli G, Orsenigo E, Staudacher C.: "Laparoscopic vs open colectomies in octogenarians : a case-matched control study", Dis Colon Rectum 2005 : 48 : 2070-5

Andrea Vignali

Department of Surgery, San Raffaele University, Milan, Italy