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

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dc.contributor.authorvan Harten, M.J.
dc.contributor.authorGreenwood, E.B.
dc.contributor.authorBedrikovetski, S.
dc.contributor.authorDudi-Venkata, N.N.
dc.contributor.authorHunter, R.A.
dc.contributor.authorKroon, H.M.
dc.contributor.authorSammour, T.
dc.date.issued2020
dc.description.abstractBackground: 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.
dc.description.statementofresponsibilityMeike J. van Harten, Emma B. Greenwood, Sergei Bedrikovetski, Nagendra N. Dudi-Venkata, Ronald A. Hunter, Hidde M. Kroon, Tarik Sammour
dc.identifier.citationEuropean Journal of Surgical Oncology, 2020; 46(9):1649-1655
dc.identifier.doi10.1016/j.ejso.2020.03.224
dc.identifier.issn0748-7983
dc.identifier.issn0748-7983
dc.identifier.orcidBedrikovetski, S. [0000-0001-9330-625X]
dc.identifier.orcidDudi-Venkata, N.N. [0000-0002-9775-3599]
dc.identifier.orcidKroon, H.M. [0000-0002-8923-7527]
dc.identifier.orcidSammour, T. [0000-0002-4918-8871]
dc.identifier.urihttps://hdl.handle.net/2440/140349
dc.language.isoen
dc.publisherElsevier
dc.rights© 2020 Elsevier Ltd
dc.source.urihttps://doi.org/10.1016/j.ejso.2020.03.224
dc.subjectRectal cancer; Elderly patients; Minimally invasive surgery (MIS); Postoperative outcomes; Length of hospital stay
dc.subject.meshMesentery
dc.subject.meshHumans
dc.subject.meshSepsis
dc.subject.meshSurgical Wound Infection
dc.subject.meshRectal Neoplasms
dc.subject.meshPostoperative Complications
dc.subject.meshSurgical Wound Dehiscence
dc.subject.meshLaparoscopy
dc.subject.meshNeoplasm Staging
dc.subject.meshNeoadjuvant Therapy
dc.subject.meshLength of Stay
dc.subject.meshPatient Readmission
dc.subject.meshProctocolectomy, Restorative
dc.subject.meshAge Factors
dc.subject.meshAdolescent
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshMiddle Aged
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshYoung Adult
dc.subject.meshPropensity Score
dc.subject.meshMinimally Invasive Surgical Procedures
dc.subject.meshRobotic Surgical Procedures
dc.subject.meshProctectomy
dc.titleMinimally invasive surgery in elderly patients with rectal cancer: An analysis of the Bi-National Colorectal Cancer Audit (BCCA)
dc.typeJournal article
pubs.publication-statusPublished

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