Influencia de la edad en el tratamiento quirúrgico del cáncer colorrectal

Abstract

This dissertation is the result of a clinical study designed with the aim to clarify the existing controversies in the elective surgical treatment of colorectal cancer in elderly patients. The work focuses on the approach (laparoscopic versus conventional), trying to clarify which approach gives better results in this selected group of patients and if is possible to define a subgroup in which one of the two ways offer better or worse outcome than the other. The thesis has been developed in two separate studies; the first refers to colon cancer and the second to rectal cancer. As a result, these two studies have been published as two articles in international journals, one published in Surgical Endoscopy and another in Colorectal Disease. 1st Study: A total of 545 patients with colon adenocarcinoma underwent elective surgery between 2005 and 2009. There were 277 patients in the laparoscopic group and 268 in the open. Patient characteristics in both groups were homogeneous and further stratified into three subgroups by age: < 75, between 75-84, and ≥ 85 years. Main outcome measures were early morbidity, mortality and hospital stay. Results: Open surgery group showed a higher overall morbidity rate (37.3% vs. 21.6%, P=0.001), medical complications (16.4% vs. 10.5%, P=0.033), surgical complications (23.5% vs. 15.5%, P=0.034) and mortality (6.7% vs. 3.2%, P=0.034). The overall morbidity rate difference between open and laparoscopy approach disappeared in the oldest group (≥85 years old). Surgical site infections rate was inferior for patients <75 years old in laparoscopy group compared with open. Mortality was also significantly inferior in laparoscopy group in younger patients (<75 years, 0% vs. 3%, P=0.038). Mean hospital stay was shorter for patients in <75 and 75-84 groups with laparoscopic approach as compared with those who underwent open surgery, but these differences disappeared in patients aged ≥85 years. 2nd Study: This was a retrospective analysis of all patients who underwent rectal surgery for cancer between 2003 and 2013 in a teaching hospital. The primary aim of this study was to assess the influence of surgical approach on mortality and morbidity of rectal resection in patient ≥80-years-old. Results: A total of 408 patients were included, 203 in the LR group and 205 in the OR group; 303 (74.3%) patients were <80-years-old, 105(25.7%) were ≥80. The mortality was lower in LR group for patients <80 compared with OR (0 vs. 4.6%; P=0.049), without differences in older patients (11.5 vs. 9.4%; P=0.859). In younger patients, OR group showed longer hospital stay (9 vs. 7 days; P<0.001) and more complications (44.1 vs. 29.8%; P=0.042). Medical complications were more frequent in LR than OR group for ultra-octogenarians (40.4 vs. 20.8%; P=0.009). At a general level, this work concludes that the advantages shown by the laparoscopic approach in elective surgery of colorectal cancer are not observed in patients over 85 years old operated on for colon cancer and in patients older than 80 years operated on for rectal cancer. In these patient subgroups, the results of laparoscopic and conventional surgery are similar.

Date of Award	14 Dec 2015
Original language	Spanish
Supervisor	Manuel Armengol Carrasco (Director), Eloy Espin-Basany (Director) & Francesc Domenec Vallribera Valls (Director)