Outcomes of laparoscopic surgery for pT3/pT4 colorectal cancer in young vs. Old patients

BACKGROUND: Laparoscopy for locally advanced colorectal cancer is not standardized yet and its potential risks and benefits in elderly patients are still under debate. The aim of this study was to evaluate clinical and oncologic results of laparoscopic surgery for pT3/pT4 lesions in both old and young people. METHODS: Between 2006 and 2015, 115 patients aged <70 years and 112 patients aged >70 years underwent elective laparoscopic surgery for pT3/pT4 colorectal cancer presenting without distant metastasis at the Department of General Surgery, Trieste. Characteristics of the study populations, including demographic, operative and tumor features, were prospectively collected and short-term and long-term clinical, pathologic and oncologic outcomes were retrospectively analyzed. RESULTS: No difference was found in terms of tumor features, type and duration of surgery, and quality of resection. Old patients were found to have significantly higher rates of conversion (P=0.02) and postoperative mortality(P=0.03), whereas postoperative complications and reintervention rates — although higher in the elderly — did not differ on statistical analysis (P=0.13 and P=0.19, respectively). Local and distant recurrence rates were not statistically different between the two groups (P=0.64 and P=0.34, respectively). Adjuvant chemotherapy was more frequently offered to young people (P<0.001), who were considered significantly healthier than old ones (P<0.001). Overall survival was significantly lower among the elderly (P=0.001), but 5-year disease-free survival did not differ between the two groups (P=0.09). CONCLUSIONS: Laparoscopic surgery for locally advanced lesions is feasible, but old patients present an increased risk of conversion and postoperative morbidity and mortality, which may alter long-term outcomes determining an apparent decrease in survival.