Laparoscopic vs. open approach for pT3/pT4 colorectal cancer in the elderly: ten-year experience in a single center

BACKGROUND: The role of laparoscopic surgery for pT3/pT4 colorectal cancer (CRC) is still under debate. The aim of this study was to compare the outcomes of laparoscopic and open procedures for pT3/pT4 CRC in elderly patients. METHODS: From January 2004 to December 2015, 225 patients aged >= 70 years underwent elective colorectal surgery for pT3/pT4 CRC at the Department of General Surgery, University Hospital of Trieste. Patients' demographics, tumor's characteristics, intraoperative factors, short-term and long-term outcomes were retrospectively analyzed. RESULTS: The study included 113 patients undergone open surgery and 112 who underwent laparoscopic surgery. Age was found to be statistically different between the two group, with open surgery patients being older than laparoscopic ones (P=0.009). The tumor location differed between the two groups (P=0.004), determining a variation in the incidence of surgical procedures performed (P<0.001). No other statistically significant differences were found in terms of intraoperative, histopathologic and oncologic factors. CONCLUSIONS: Laparoscopy is as safe as open surgery for pT3/pT4 CRC and it is often feasible, though in old patients higher conversion rates should be anticipated than in younger ones.