Minimally invasive surgery for colorectal cancer in the elderly patients

Abstract

There is an increasing population of elderly people in Western as well as in Asian countries. Among the malignant tumors colorectal cancer is one of the most frequently seen tumors in the elderly. Since the first report by Jacobs in 1991 (Jacobs et al., Surg Laparosc Endosc 1: 144-50, 1991), laparoscopic colorectal surgery has been practiced with an increasing number of cases each year. As laparoscopic colorectal surgery is less invasive than open surgery, it will be a good indication for elderly patients who tend to have comorbidity and/or frailty. Most of the short-term postoperative studies comparing laparoscopic vs open in elderly patients demonstrated the advantages of laparoscopic colectomy over open colectomy. The results of these reports demonstrated that although the length of operation was longer in laparoscopic colectomy, the postoperative hospital stay was shorter and the return of bowel function was earlier. Most of the retrospective studies showed that laparoscopic colorectal surgery in the elderly patients can safely be performed as in the younger patients. However, due to the retrospective nature of the studies, still it is not yet clearly determined whether elderly patients with comorbidities can safely be operated on as in younger patients with similar comorbidities. As the indication for laparoscopic colectomy in the elderly patients expands including those with high-grade cardiopulmonary comorbidities, it should be further investigated whether the indication for laparoscopic colectomy can similarly be indicated in the elderly as in the younger patients.