Surgery Techniques Matter for Colorectal Cancer Patients

Colorectal cancer treated with laparoscopic surgery improved outcomes in elderly patients

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Elderly cancer patients typically are not as strong as their younger counterparts. They often don’t recover as quickly from surgery and may need special attention. Researchers have found that one surgical technique may improve the outlook for elderly colorectal cancer patients.

Patients over the age of 70 with colorectal cancer were more likely to return home instead of to a nursing home following minimally invasive surgery than after open surgery.

The researchers learned that three-year survival rates were the same for both types of surgery, but those having minimally invasive procedures enjoyed a better quality of life and more independence.

"Plan for your recovery after cancer surgery."

Richard Liu, MD, a resident in general surgery at Dalhousie University in Halifax, Nova Scotia, and colleagues mined data from the Nationwide Inpatient Sample (NIS), a massive database with information on inpatient care from more than 1,000 hospitals.

The goal of the study was to look at where elderly colorectal cancer patients over the age of 70 recovered following open and laparoscopic surgery.

Traditional open surgery involves a single incision through which the surgeon enters the abdomen.

In laparoscopic surgery, very small incisions are made, and a tubular instrument called a trochar is inserted. A special camera called a laparoscope is used to transmit images of the abdomen to video monitors in the operating room. The surgeon uses these images to locate and remove the cancerous tumor(s).

Using the NIS database, the investigators identified and looked at the records of 9,416 elderly patients who had undergone colon cancer surgery between 2009 and 2011— 5,704 of whom had open surgical resection and 3,712 of whom had laparoscopic procedures.

Of the patients who had open surgery, 20 percent went from the hospital to a nursing facility, compared to 12.5 percent of elderly patients who had laparoscopic procedures.

Upon analysis, researchers found laparoscopic surgery decreased the chances of being released to a nursing facility by 39 percent.

When examining different age ranges, the researchers discovered that individuals between the ages of 70 and 75 were the least likely to go to a nursing facility following surgery.

Folks aged 75 to 80 years were two times more likely to need nursing home care after surgery than patients between 70 and 75 years of age. Patients between the ages of 80 and 85 were four times more likely, and individuals over the age of 85 were eight times more likely to go to a nursing facility than patients between the ages of 70 and 75.

Additionally, according to the authors, patients who had other serious health issues such as diabetes or heart disease and female patients were more likely to end up in a nursing home than at home following surgery. Patients in hospitals in the South and West and African-American patients were less likely to go to a skilled nursing facility.

"Laparoscopic colon cancer resection [surgical removal] in elderly patients is associated with decreased risk of discharge to a nursing facility compared with open resection. Loss of independence should be considered when determining the appropriate procedure in this population," the authors concluded.

"Laparoscopic surgery for elderly colorectal cancer patients is entirely appropriate,” Richard N. Berri, MD, FACS, director of Surgical Oncology and Peritoneal Malignancies Program at St. John Hospital and Medical Center in Detroit, MI, told dailyRx News.

“Not only does it provide the same survival benefits as open surgery, but this approach offers a significant improvement in recovery and quality of life," said Dr. Berri, who was not involved in the study.

Findings from this research were presented at the 2013 Clinical Congress of the American College of Surgeons.

All research is considered preliminary before it is published in a peer-reviewed journal.

Review Date: 
October 8, 2013
Last Updated:
October 8, 2013