Risk factors for postoperative complications in laparoscopic and robot-assisted surgery for octogenarians with colorectal cancer: A multicenter retrospective study

Aim

Minimally invasive surgery for colorectal cancer is increasing globally. However, the safety in older patients have not been thoroughly examined.

Methods

Patients with colorectal cancer who underwent laparoscopic or robot-assisted surgery at Kyoto University Hospital and 18 affiliated institutions in Japan that participated in the Kyoto Colorectal Surgery Group between 2018 and 2023 were enrolled. Focusing on patients ≥80 y, we investigated the risk factors for postoperative complications.

Results

In total, 7303 patients were enrolled in this study. The mean age was 71 ± 11 y, with 1665 patients (22.8%) ≥80 y old. Older patients (≥80 y) had significantly higher ASA and ECOG-PS scores and more comorbidities including diabetes, chronic obstructive pulmonary disease (COPD), hypertension, heart disease, and cerebrovascular disease than patients ≤79 y old (all p < 0.05). In the older group, postoperative complications (Clavien–Dindo grade ≥II) occurred in 210 patients (12.6%). After adjusting for covariates using the multivariable logistic regression model, rectal cancer (odds ratio [OR]: 1.84, 95% confidence interval [CI]: 1.30–2.60, p = 0.001), operation time ≥300 min (OR: 1.52, 95% CI: 1.07–2.16, p = 0.020), and blood loss ≥100 mL (OR: 2.19, 95% CI: 1.80–3.24, p < 0.001) were associated with the occurrence of complications, whereas their comorbidities showed no association.

Conclusion

In minimally invasive colorectal cancer surgery for older patients (≥80 y old), prioritizing shorter operation time and blood loss control is crucial, especially for patients with rectal cancer because of their high risk of complications.