Minimally invasive surgery in elderly patients with rectal cancer: An analysis of the Bi-National Colorectal Cancer Audit (BCCA)

Abstract

Background: Advanced age is associated with worse outcomes after open rectal cancer surgery. However, not much is known about outcomes of minimally invasive surgery (MIS) in the elderly. The aim of this study was to evaluate safety and efficacy of MIS in elderly rectal cancer patients using the Bi-national Colorectal Cancer Audit (BCCA) data from Australia and New Zealand (ANZ). Methods: 3451 patients were included, divided into three groups: <50 years (n ¼ 364), 50e74 years (n ¼ 2157) and 75 years (n ¼ 930). Propensity-score matching was performed for the elderly group analysis to correct for differences in baseline characteristics. Results: MIS was performed in 52.9% of elderly patients, slightly lower than rates in <50 year and 50e74 year old groups (61% and 55.5%, respectively, p ¼ 0.022). Elderly patients had more postoperative complications (p < 0.0001) and had a longer length of hospital stay (LOS; median 11 vs. 8 days for both other groups; p < 0.0001). Elderly patients had higher (y)pT-stages compared to both other groups (p < 0.0001) and were less likely to receive adjuvant therapy (p < 0.0001). Propensity-score matched analysis of the elderly group showed a higher rate of superficial wound dehiscence and a longer LOS after open surgery compared to MIS (10.3% vs. 2.6%, p ¼ 0.030; 12 days vs. 9.5 days, p ¼ 0.001, respectively), with comparable short-term oncological outcomes. Conclusions: MIS is performed in just over half of elderly rectal cancer patients who are selected for elective rectal resection surgery in ANZ. When performed in the elderly, MIS appears safe and is associated with fewer wound complications and a shorter LOS.