Laparoscopic Colectomy in the Elderly: When Is Too Old?

ABSTRACT

To date, there is little literature regarding the impact of laparoscopic colectomy in the elderly population (i.e., patients older than 70 years) as the vast majority of studies regarding laparoscopic colectomy have evaluated younger patients (younger than 65 years). It is unknown whether elderly patients garner the same benefits from laparoscopic colectomy that younger patients have been shown to receive. As a result, there may be a reluctance to offer laparoscopy to elderly patients. The majority of the reports suggest that laparoscopic colectomy in the elderly is safe and provides the same benefits as laparoscopic colectomy in a younger population. Although an elderly population does not return to the work force, the benefits in the elderly population are related to a return to independence more often than after conventional surgery without an increase in hospital costs. Based on the current literature, one may never be too old to have a laparoscopic colectomy.

Laparoscopy - age - elderly - physiology

REFERENCES

• 1 Spivak H, Vande Maele D, Friedman I et al.. Colorectal surgery in octogenarians.  J Am Coll Surg. 1996;  183 46-50
• 2 Chen H H, Wexner S D, Weiss E G et al.. Laparoscopic colectomy for benign colorectal disease is associated with a significant reduction in disability as compared with laparotomy.  Surg Endosc. 1998;  12 1397-1400
• 3 Marcello P W, Milsom J W, Wong S K et al.. Laparoscopic total colectomy for acute colitis: a case-control study.  Dis Colon Rectum. 2001;  44 1441-1445
• 4 Milsom J W, Hammerhofer K A, Bohm B et al.. Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease.  Dis Colon Rectum. 2001;  44 1-9
• 5 Schwenk W, Bohm B, Muller J M. Postoperative pain and fatigue after laparoscopic or conventional colorectal resections.  Surg Endosc. 1998;  12 1131-1136
• 6 Weeks J C, Nelson H, Gelber S et al.. Short-term quality of life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer.  JAMA. 2002;  287 321-328
• 7 Vara-Thorbeck C, Garcia-Caballero M, Salvi M. Indications and advantages of laparoscopic-assisted colon resection for carcinoma in elderly patients.  Surg Laparosc Endosc. 1994;  4 110-118
• 8 Peters W, Fleshman J. Minimally invasive colectomy in elderly patients.  Surg Laparosc Endosc. 1995;  5 477-479
• 9 Reissman P, Agachan F, Wexner S D. Outcome of laparoscopic colorectal surgery in older patients.  Am Surg. 1996;  10 1201-1203
• 10 Schwandner O, Schiedeck T HK, Bruch H P. Advanced age-indication or contraindication for laparoscopic colorectal surgery?.  Dis Colon Rectum. 1999;  42 356-362
• 11 Delgado S, Lacy A M, Garcia-Valdecasas J C et al.. Could age be an indication for laparoscopic colectomy in colorectal cancer?.  Surg Endosc. 2000;  14 22-26
• 12 Law W L, Chu K W, Tung P HM. Laparoscopic colorectal resection: a safe option for elderly patients.  J Am Coll Surg. 2002;  195 768-773
• 13 Seshadri P A, Mamazza J, Schlachta C M et al.. Laparoscopic colorectal resection in octogenarians.  Surg Endosc. 2001;  15 802-805
• 14 Schlachta C M, Mamazza J, Seshadri P A et al.. Determinants of outcomes in laparoscopic colorectal surgery: a multiple regression analysis of 416 resections.  Surg Endosc. 2000;  14 258-263
• 15 Payne J E, Chapuis P H, Pheils M T. Surgery for large bowel cancer in people aged 75 years and older.  Dis Colon Rectum. 1986;  29 733-737
• 16 Bufalari A, Ferri M, Cao P et al.. Surgical care in octogenarians.  Br J Surg. 1996;  83 1783-1787
• 17 Stewart B T, Stitz R W, Lumley J W. Laparoscopically assisted colorectal surgery in the elderly.  Br J Surg. 1999;  86 938-941
• 18 Iroatulam A JN, Chen H H, Potenti F M et al.. Laparoscopic colectomy yields similar morbidity and disability regardless of patient age.  Int J Colorectal Dis. 1999;  14 155-157
• 19 Tuech J J, Pessaux P, Rouge C et al.. Laparoscopic vs open colectomy for sigmoid diverticulitis: a prospective comparative study in the elderly.  Surg Endosc. 2000;  14 1031-1033
• 20 Stocchi L, Nelson H, Young-Fadok T M et al.. Safety and advantages of laparoscopy vs. open colectomy in the elderly: matched-control study.  Dis Colon Rectum. 2000;  43 326-332
• 21 Mutch M G, Marcello P W, Schoetz D J et al.. Laparoscopic versus open colectomy in the elderly: is there an advantage?.  Dis Colon Rectum. 2002;  45 A56 , (Abstract)
• 22 Sklow B, Birnbaum E, Read T, Fry R, Fleshman J. Age and type of procedure influence the choice of patients for laparoscopic colectomy.  Surg Endosc. 2003;  17 923-929
• 23 Bardram L, Funch-Jensen P, Kehlet H. Rapid rehabilitation in elderly patients after laparoscopic colonic resection.  Br J Surg. 2000;  87 1540-1545
• 24 Senagore A J, Madbouly K M, Fazio V W et al.. Advantages of laparoscopic colectomy in older patients.  Arch Surg. 2003;  138 252-256
• 25 Matsuoka H, Masaki T, Mori T et al.. Laparoscopy-assisted surgery for colorectal neoplasm is justifiable regardless of advanced age.  Hepatogastroenterology. 2004;  51 152-155
• 26 Scheidbach H, Schneider C, Hugel O et al.. Laparoscopic surgery in the old patient: do indications and outcomes differ?.  Langenbecks Arch Surg. 2005;  390 328-332
• 27 Vignali A, Di Palo S, Tamburini A et al.. Laparoscopic vs. open colectomies in octogenarians: a case-matched control study.  Dis Colon Rectum. 2005;  48 2070-2075