Safety Of Surgical Treatment For Colorectal Cancer In Patients With Basic Diseases Aged Above 75 Years And The Short-term Outcome And Feasibility Of Laparoscopic Surgery

Objective:To evaluate surgical safety of aged colorectal patients with basic diseases older than 75 years and the short-term outcome and feasibility of laparoscopic colorectal surgery.Methods:The clinical data of 91 colorectal carcinoma patients aged with basic diseases above 75 years old treated by operative procedures from January 2013 to February 2015 were analyzed retrospectively. Pre-operative diseases and treatment methods,intraoperative operating time and blood loss,the recovery of gastrointestinal function after surgery,postoperative complications and incidence and mortality were analyzed.Moreover all patients were divided into Laparoscopy group(n=33,male 21,female 18) and Open group(n=58, male 40,female 18).The overall median age was 79 years(75-90years) and the median age of Laparoscopy group was 78 years(75-90 years) and Open group was 79 years(75-88years). ASA and NYHA classification,Pre-operative diseases,Pathological staging(TNM staging),intraoperative operating time and blood loss,the recovery of gastrointestinal function after surgery,postoperative hospital stay,postoperative complications and incidence and mortality were compared between the two groups.Results:91 patients were successfully completed operation,included right hemicolectomy 17 cases, transverse colonresection 2 cases, left colectomy 4 cases, sigmoid resection 14 cases, rectal resection 43 cases, Abdominal perineal resection 8 cases, Hartmann 3 cases. The mean operating time( 174±60)min, the median of blood loss(165±126)ml, anus or stoma exhaust time(4.38±1.14)d, postoperative hospital stay(11.99±4.77)d, the overall incidence of postoperative complications was 53.8%(49/91),included pulmonary infection 39 cases(42.9%,39/91), severe lung infection 12 cases(13.2%,12/91), abdominal infection 4cases, acute left ventricular failure 1 case, right heart failure 1 cases, anastomotic leak 2 cases, early postoperative ileus 3 cases, incision liquefaction or infection 10 cases, urinary retention or urinary tract infections 4 cases, severe electrolyte imbalance 1cases, Venous catheter thrombosis 1 case, acute cholecystitis 1 case, acute epididymitis 1case. No postoperative deaths.No significant differences in ASA grade( P=0.722), NYHA grade( P=0.676),Pre-operative diseases( X2=3.388,P=0.184) and TNM staging(P=0.945)were found between the two groups. Laparoscopic group of intraoperative bleeding volume was less than the open group, the difference was statistically significant(F=6.879, P=0.001), laparoscopic operation time is longer than the open group, the difference was statistically significant(F=11.391, P= 0.001), laparoscopic postoperative anal fistula or exhaust time is shorter than the open group, the difference was statistically significant(F=40.022, P<0.001),laparoscopic postoperative hospital stay in laparoscopic group is less than the open surgery group, the difference was statistically significant(F=4.942, P=0.029) inlaparoscopic group, peri operation period of the incidence of complications was lower than the laparotomy group, the difference was statistically significant(X2=5.326,P=0.021). Perioperative mortality(0).Conclusions:75-year-old age of colorectal cancer and more complicated by systemic chronic underlying diseases in patients undergoing surgery, despite the higher incidence of postoperative complications, but after full preoperative preparation and postoperative active treatment was well tolerated in elderly patients surgery. 75 years and over complicated by systemic underlying diseases elderly patients with colorectal cancer who underwent laparoscopic surgery compared with traditional open surgery with a faster recovery, less bleeding, shorter hospital stay after surgery, complication rate, etc., and at the same time no increase in perioperative mortality. So, for more than the combined basis of systemic disease of elderly patients with colorectal cancer, laparoscopic surgery compared with open surgery has certain advantages of short-term outcome. Laparoscopic surgery for 75 years and over complicated by systemic underlying diseases elderly patients with colorectal cancer is safe and feasible.