Benefits of minimally-invasive surgery for sigmoid and rectal cancer in older adults compared with younger adults: Do older adults have the most to gain?. Issue 5 (June 2020)

• Record Type: Journal Article
• Authors: Chesney, Tyler R.; Quereshy, Humzah A.; Draginov, Arman; Chadi, Sami A.; Quereshy, Fayez A.
• Is Part Of: Journal of geriatric oncology. Volume 11:Issue 5(2020)
• Page Start: 860
• Page End: 865
• Publication Date: 2020-06
• Subjects: Older adults -- Laparoscopic -- Minimally-invasive -- Colorectal surgery; Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2019.09.018
• Languages: English
• ISSNs: 1879-4068

Abstract

Abstract: Introduction: Randomized trials demonstrated oncologic safety and short-term benefits of laparoscopy. We investigated if the benefit of laparoscopy on short-term outcomes is greater for older adults compared with younger adults. Methods: We identified all older (≥70 years old) and younger (<70) adults with primary sigmoid and rectal cancer treated with resection between 2002 and 2018 from an institutional database. We compared 30-day postoperative outcomes using multivariable logistic regression with an interaction term between age group and surgical approach. Primary outcomes were death, major (Clavien-Dindo III-IV) and minor (Clavien-Dindo I-II) complications, and wound complications. Results: We included 792 patients, 293 (37%) older and 499 (63%) younger. Use of laparoscopy was similar between age groups: 120/293 (41%) older, 204/499 (41%) younger ( p = .98). All patients had 30-day follow-up. Compared with open resection, minimally-invasive resection was associated with a greater reduction in deaths in older adults than in younger adults (absolute difference in older adults 7.0% less versus 2.1% less in younger adults; adjusted odds ratio [aOR] older 3.01, 95% confidence interval [CI] 1.31–7.33; aOR younger 0.31, 95% CI 0.05–1.24; interaction p = .01). Similarly, minimally-invasive resection was associated with a greater reduction in major complications in older adults than in younger adults (absolute difference in older adults 6.4% less versus 2.4% less in younger adults; aOR older 1.91, 95% CI 1.07–3.41; aOR younger 0.70, 95% CI 0.34–1.38; interaction p = .03). Conclusions: Minimally-invasive compared with open surgery demonstrated a differential benefit on postoperative death and major complications between younger and older adults.