Laparoscopy Can Safely be Performed in Frail Patients Undergoing Colon Resection for Cancer

• Published in: The American surgeon 2017-10, Vol.83 (10), p.1179-1183
• Main Authors: Ho, Be, Lewis, Aaron, Paz, I. Benjamin
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Age Factors; Aged; Aged, 80 and over; Aging; Anemia; Body mass; Body mass index; Body size; Cancer; Colectomy - methods; Colon; Colon cancer; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - mortality; Colorectal Neoplasms - surgery; Colorectal surgery; Complications; Databases, Factual; Elective Surgical Procedures - methods; Female; Frail Elderly; Frailty; Humans; Laparoscopy; Logistic Models; Male; Medical personnel; Middle Aged; Morbidity; Mortality; Multivariate analysis; Older people; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative period; Quality; Quality control; Rectum - surgery; Risk Factors; Studies; Surgery; Surgical outcomes; Tobacco; Treatment Outcome; Womens health; Young Adult
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481708301034

The present study aims to evaluate the role of laparoscopy in frail patients undergoing colorectal surgery for colorectal cancer. A review of the 2011 to 2014 American College of Surgeons National Surgical Quality Improvement Program database was performed to identify frail patients (using a frailty index), who underwent resection for colorectal cancer. Univariable and multivariable analyses were performed to evaluate 30-day mortality and Clavien–Dindo grade IV (CD-IV) complications. A total of 52,087 patients with colorectal cancer were identified, of which frailty accounted for 2.63 per cent (index score ≥5). Patients above the age 85 were considered frail 6.8 per cent of the time and accounted for 24.5 per cent of patients with frailty. Laparoscopic surgery was performed in 32.9 and 53.1 per cent of patients with and without frailty (P < 0.001). Patients with frailty were less likely to die within 30 days of surgery if younger (P = 0.004), performed electively (P < 0.001), or laparoscopically (P < 0.001). On multivariate analysis, laparoscopy and elective surgery were associated with better perioperative survival; whereas, older age, male sex, and tobacco use were associated with 30-day mortality. Laparoscopy and lower body mass index were associated with fewer Clavien–Dindo grade IV complications. Although laparoscopy is performed less commonly in the frail, this study indicated better perioperative outcomes for patients undergoing elective surgery who were