대장암 진단을 받은 75세 이상의 환자군에서의 복강경 수술의 유용성 (Can Elderly Patients Older than 75 Years with Colorectal Cancer Tolerate Planned Laparoscopic Surgery?)

서지정보

· 발행기관 : 대한내시경로봇외과학회
· 수록지 정보 : Journal of Minimally Invasive Surgery / 15권 / 4호 / 126 ~ 132페이지
· 저자명 : 이강산, 김영완, 김주희, 권현준, 김익용

초록

Purpose: Colorectal resection for elderly patients is associated with significant morbidity and mortality. It is still unclear whether or not laparoscopic colorectal resection (Lap CR) is indicated in elderly patients. The aim of this study is to evaluate the outcome of colonic surgery in elderly patients and to assess the feasibility and safety of laparoscopic colorectal surgery in elderly patients.
Methods: Patient characteristics and perioperative and pathologic data on 295 patients who underwent Lap CR for cancer from Jan. 2004 to Aug. 2011 were prospectively collected. Exclusion criteria were emergency and palliative bypass surgery. Outcomes for elderly patients (≥75 years) were compared with those of younger patients (＜75 years).
Results: In comparison of 257 younger patients (＜75 years, median age 61 years), 38 elderly patients (≥75 years, median age 79 years) showed a greater proportion off emale gender (52.6% vs. 37.0%, p=0.065) and American Society of Anesthesiologists score 2∼3 (97.3% vs.42.0%, p＜0.001). No differences in tumor location, median operative time, conversion rate, duration of hospital stay, and perioperative complications (23.7% vs. 30.0%, p=0.427) were observed between the two groups. Distributions of American Joint Committee on Cancer stages and number of harvested lymph nodes were comparable between groups.
Conclusion: Although elderly patients are more likely to be affected by co morbidities, postoperative outcome in this group after Lap CR is comparable with that of younger patients. Use of Lap CR in elderly patients is safe, and is associated with a low morbidity. It should be also regarded as the optimal approach for very elderly patients.

영어초록

Purpose: Colorectal resection for elderly patients is associated with significant morbidity and mortality. It is still unclear whether or not laparoscopic colorectal resection (Lap CR) is indicated in elderly patients. The aim of this study is to evaluate the outcome of colonic surgery in elderly patients and to assess the feasibility and safety of laparoscopic colorectal surgery in elderly patients.
Methods: Patient characteristics and perioperative and pathologic data on 295 patients who underwent Lap CR for cancer from Jan. 2004 to Aug. 2011 were prospectively collected. Exclusion criteria were emergency and palliative bypass surgery. Outcomes for elderly patients (≥75 years) were compared with those of younger patients (＜75 years).
Results: In comparison of 257 younger patients (＜75 years, median age 61 years), 38 elderly patients (≥75 years, median age 79 years) showed a greater proportion off emale gender (52.6% vs. 37.0%, p=0.065) and American Society of Anesthesiologists score 2∼3 (97.3% vs.42.0%, p＜0.001). No differences in tumor location, median operative time, conversion rate, duration of hospital stay, and perioperative complications (23.7% vs. 30.0%, p=0.427) were observed between the two groups. Distributions of American Joint Committee on Cancer stages and number of harvested lymph nodes were comparable between groups.
Conclusion: Although elderly patients are more likely to be affected by co morbidities, postoperative outcome in this group after Lap CR is comparable with that of younger patients. Use of Lap CR in elderly patients is safe, and is associated with a low morbidity. It should be also regarded as the optimal approach for very elderly patients.

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