Propensity-Score Matched Analysis of Short-term Outcomes of Laparoscopic Compared to Open Surgery in Octogenarian and Nonagenarian Patients With Colon Cancer

Laparoscopy has become standard treatment for colorectal cancer. Elderly patients with comorbidities may have additional risks associated with laparoscopic surgery given their frailty and functional status. We aimed to investigate the safety and benefits of laparoscopic surgery for colon cancer in patients ≥80 years with significant medical comorbidities.

The NCDB was searched for patients ≥80 years with stage I-III colon cancer who underwent radical resection from 2010-2019. Patients were classified into two groups: open and laparoscopic colectomy and were propensity-score matched for disease stage, tumor location and size, and treatment facility. Primary outcome was 30- and 90-day mortality; hospital stay, 30-day readmission, resection margin status, and overall survival (OS) were secondary outcomes.

After matching, 7314 patients (57.9% females; median age: 84 years) were included; 3657 patients were in each group. Conversion rate from laparoscopic to open colectomy was 13.8%. Laparoscopic colectomy was associated with lower odds of 30-day mortality (OR: 0.61, 95% CI: 0.52, 0.73, P < .001), 90-day mortality (OR: 0.64, 95% CI: 0.56, 0.74, P < .001), positive resection margins (3.7% vs 5.5%, OR: 0.65, 95% CI: 0.52, 0.82, P < .001), shorter hospital stays (median: 6 vs 7 days, P < .001), and longer OS (median: 49.8 vs 39.7 months, P < .001) than open surgery. Both groups had similar unplanned 30-day readmission rates (6.6% vs 6%, P = .082) and number of harvested lymph nodes.

Laparoscopic surgery was associated with significant benefits in patients with colon cancer aged ≥80, including less short-term mortality, shorter hospital stays, more R0 resections, and potentially longer survival, compared to laparotomy.