Department of Surgery, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan.
Surg Laparosc Endosc Percutan Tech. 2020 Nov 23;31(3):337-341. doi: 10.1097/SLE.0000000000000876.
Super-elderly patients with colorectal cancer are being encountered with increasing frequency in Japan. Laparoscopic surgery is considered a less invasive surgery in these patients; however, it is difficult to conduct controlled clinical trials in this super-elderly population. This study assessed the feasibility and safety of laparoscopic colorectal surgery in patients over 85 years old.
Open and laparoscopic surgeries for colorectal cancer in super-elderly patients (aged 85 y and older) were performed under general anesthesia in a single medical center. Records were retrospectively reviewed, and the clinicopathologic features of each patient and the surgical time and outcomes were recorded and analyzed.
Records of colorectal surgery were reviewed for 108 super-elderly patients. Twenty-six open surgeries and 82 laparoscopic surgeries were performed. The mean operation times were 215 and 228 minutes in open and laparoscopic surgeries, respectively. Intraoperative bleeding in laparoscopic surgery was lesser than that in open surgery. There were 2 cases with major postoperative complications in open surgery, and mortality occurred in one case within 1 month after surgery. No major complications were observed in laparoscopic surgery. In survival analysis, disease-free survival did not differ between the 2 groups. The oldest patient was a man aged 102 years and 6 months who underwent laparoscopic anterior resection with lymph node dissection.
Laparoscopic surgery in super-elderly patients with colon cancer is feasible and safe. The authors report the success of laparoscopic colectomy for rectosigmoid colon cancer in the oldest known patient and the positive outcomes of laparoscopic colectomy in super-elderly patients.
日本越来越多地遇到患有结直肠癌的超高龄患者。腹腔镜手术被认为是这些患者的一种微创手术；然而，在这个超高龄人群中进行对照临床试验是困难的。本研究评估了腹腔镜结直肠手术在 85 岁以上患者中的可行性和安全性。
在一家医疗中心，对 85 岁及以上的超高龄患者进行了开腹和腹腔镜结直肠癌手术，全身麻醉下进行。回顾性审查记录，并记录和分析每位患者的临床病理特征、手术时间和结果。
对 108 例超高龄患者的结直肠手术记录进行了审查。行 26 例开腹手术和 82 例腹腔镜手术。开腹手术和腹腔镜手术的平均手术时间分别为 215 分钟和 228 分钟。腹腔镜手术的术中出血量少于开腹手术。开腹手术中有 2 例发生重大术后并发症，1 例术后 1 个月内死亡。腹腔镜手术未观察到重大并发症。在生存分析中，两组之间无病生存率无差异。最年长的患者是一名 102 岁 6 个月的男性，接受了腹腔镜直肠前切除术和淋巴结清扫术。
腹腔镜手术治疗高龄结肠癌患者是可行且安全的。作者报告了首例已知最年长患者的腹腔镜直肠乙状结肠切除术成功案例，以及腹腔镜结直肠切除术在超高龄患者中的积极结果。
