Advanced age - Indication or contraindication for laparoscopic colorectal surgery?

PURPOSE: It has been proposed that laparoscopic colorectal surgery offers s everal benefits to patients. The aim of this study was to evaluate particul arly whether older patients can benefit by laparoscopic colorectal procedur es or if minimally invasive procedures are contraindicated. METHODS: All pa tients who underwent elective surgery were divided into age-related groups: patients 50 years of age or younger, patients ranging from 51 to 70 years of age, and patients older than 70 years. The groups by age were com pared with each other relative to their cardiopulmonary status, indication, proce dure, conversion, morbidity, mortality, duration of surgery, perioperative blood transfusion, stay on the intensive care unit, and hospitalization. St atistical analysis included univariate analysis by chi-squared tests and St udent's t-tests comparing patients older than 70 years with patients 50 yea rs of age or younger and with patients ranging from 51 to 70 years of age ( statistical significance was defined as P < 0.05). RESULTS: Within five yea rs 298 patients (male/female ratio, 0.38) underwent a laparoscopic or lapar oscopic-assisted colorectal procedure. Of these, 95 (31.9 percent) patients were older than 70 years, 138 (46.3 percent) patients ranged from 51 to 70 rears of age, and 65 (21.8 percent) patients were 50 pears of age of young er. Pathologic findings in cardiopulmonary function increased with age. The re were no statistically significant differences among the younger, middle- aged, and older patients relative to the incidence of conversion (3.1 vs. 9 .4 vs. 7.4 percent, respectively), major complications (4.6 vs. 10.1 vs. 9. 5 percent, respectively), minor complications (12.3 vs. 15.2 vs. 12.6 perce nt, respectively) or total laparotomy rate (7.7 vs. 12.3 vs. 12.6 percent, respectively). P > 0.05 for all com parisons. However, duration of surgery, stay on the intensive care unit, and postoperative hospitalization were si gnificantly prolonged in patients older than 70 years (P < 0.05 for all com parisons) but were reduced during the five years of experience with these p rocedures. CONCLUSIONS: If preoperative assessment of comorbid conditions a nd perioperative care was ensured, laparoscopic procedures were shown to be safe options in the elderly. The outcome of laparoscopic colorectal surger y in patients older than 70 years is similar to that noted in younger patie nts. Advanced age is no contraindication for laparoscopic colorectal surger y.