The Short-term Efficacy And Safety Evaluation Of Laparoscopy Compares With Open Surgery Treatment In The Elderly Patients With Rectal Cancer

Objective:To evaluate the safety,feasibility and short-term efficacy of laparoscopic minimal invasive surgery for elderly rectal cancer patients aged 65 years and over,compared with conventional laparotomy.Methods:We retrospectively analyzed the data of 256 cases of elderly patients（≥65years old）who undertaken anterior resection of rectum from January 1st 2013 to August1st 2017 in the department of general surgery.They were divided into two groups by the type of surgery.There were 111 cases in the laparoscopic minimal invasive surgery group（observation group）and 145 cases in the traditional open surgery group（control group）.The surgical indicators,short-term efficacy and postoperative complications were analyzed and compared.Results:All patients had successfully completed the treatment.By analyzing clinical data of 256 patients,there were no significant statistical difference in the age,sex,BMI,ASA classification,TNM staging,surgical approach（Dixon,Hartmann and Miles）,Preoperative albumin and common preoperative comorbidities（P>0.05）.However,the mean operation time of the observation group is more than the control group（196.26±56.465min vs 159.60±46.944min,P<0.05）,the mean total hospitalization expenses of observation group is significantly higher than that of control group（74211.7±26410.9 vs 58421.1±21704.0元,P<0.05）.The laparoscopic minimal invasive group’s mean intraoperative blood loss volume（114.22±62.638ml vs148.83±93.376ml,P<0.05）,the mean total duration of hospitalization（19.98±7.857d vs 20.8±7.367d,P<0.05）,mean retention of gastric tube time（2.13±1.754d vs3.60±1.970d,P<0.05）,mean preserved time of urethral catheter（8.69±3.680d vs9.79±3.851d,P<0.05）and mean postoperative gastrointestinal function recovery time（2.71±1.724d vs 3.79±2.688d,P<0.05）are significant less than traditional open surgery group.The postoperative complication rates of the observation group and control group are（18.0%vs 29.7%,P<0.05）respectively.Nevertheless,in the laparoscopic group there is a significant rise in PaCO₂（44.117±5.0206 vs 39.734±6.2564mmHg,P<0.05）and so does in the Albumin on the first postoperative day（32.076±3.3689 vs30.991±3.4917g/L,P<0.05）.Conclusions:The application of laparoscopic minimal invasive surgery in older patients with rectal cancer can significantly reduce the intraoperative blood loss,retention of gastric tube time,preserved time of urethral catheter,postoperative gastrointestinal function recovery time and postoperative hospital stay especially significantly reduce the rate of postoperative complication.The laparoscopic minimal invasive surgery is safe and effective in the treatment of rectal cancer in the elderly.