Factores de morbimortalidad postoperatoria tras cirugía laparoscópica por cáncer de colon en pacientes octogenarios / Postoperative morbidity and mortality factors after laparoscopic resection for colon cancer in octogenarians

Introducción: Dado el aumento del diagnóstico de cáncer de colon y el acceso al tratamiento en pacientes mayores de 80 años, nuestro objetivo es valorar si el abordaje laparoscópico sigue aportando las ventajas demostradas en la recuperación postoperatoria, al tiempo que analizamos los factores que pueden influir en dichos resultados. Material y método Se han analizado retrospectivamente 593 pacientes, intervenidos de cáncer de colon por laparoscopia de forma electiva entre enero de 1999 y diciembre de 2010. Se dividieron en 33 grupos: A) menores de 70 años (n = 230), B) 70-79 años (n = 209), C) mayores o igual a 80 años (n=154). Las variables independientes: sexo, enfermedades asociadas, cirugía abdominal previa, índice de Karnosfky, índice de masa corporal (IMC), nivel de hemoglobina, proteínas y albúmina, CEA, grado de ASA, localización y estadificación tumoral. Variables dependientes perioperatoria: conversión, tiempo operatorio y pérdidas hemáticas; y postoperatorias: complicaciones locales y generales, requerimiento de unidad de cuidados intensivos, reintervenciones, estancia hospitalaria y éxitus. Resultados El grupo C presentó una mayor incidencia (p<0,001) de hipertensión arterial, diabetes mellitus, cardiopatía, neumopatía y ASA grado 3, así como valores inferiores de índice de Karnofsky, IMC, hemoglobina, albúmina y proteínas totales. Durante el postoperatorio se observó (p>0,001), mayor incidencia de complicaciones generales (respiratorias y urinarias), reintervenciones, ingresos en unidad de cuidados intensivos, éxitus y mayor estancia hospitalaria. Conclusión Aunque la cirugía laparoscópica ofrece ventajas a los pacientes mayores de 80 años con cáncer de colon, este grupo de pacientes presenta un mayor riesgo de complicaciones que la población más joven y, en consecuencia, debemos ser cuidadosos en su manejo (AU)

Introduction: Given the increase in the diagnosis in colon cancer and the access to treatment in patients over 80 years old, our aim is to assess whether laparoscopic surgery still has the demonstrated advantages in post-operative recovery, as well as to analyse the factors that may influence these results. Material and method: A retrospective analysis was made on a total of 593 patients subjected to elective laparoscopy surgery due to cancer of the colon between January 1999 and December 2010. They were divided into three age groups: A) less than 70 years (n = 230),B) 70-79 years (n = 209), C) 80 years or over (n = 154). The independent variables were: gender, concomitant diseases, previous abdominal surgery, Karnosfky index, BMI, level of, haemoglobin, proteins and albumin, CEA, and ASA grade, location (..) (AU)

[Postoperative morbidity and mortality factors after laparoscopic resection for colon cancer in octogenarians]. / Factores de morbimortalidad postoperatoria tras cirugía laparoscópica por cáncer de colon en pacientes octogenarios.

INTRODUCTION: Given the increase in the diagnosis in colon cancer and the access to treatment in patients over 80 years old, our aim is to assess whether laparoscopic surgery still has the demonstrated advantages in post-operative recovery, as well as to analyse the factors that may influence these results. MATERIAL AND METHOD: A retrospective analysis was made on a total of 593 patients subjected to elective laparoscopy surgery due to cancer of the colon between January 1999 and December 2010. They were divided into three age groups: A) less than 70 years (n = 230), B) 70-79 years (n = 209), C) 80 years or over (n=154). The independent variables were: gender, concomitant diseases, previous abdominal surgery, Karnosfky index, BMI, level of, haemoglobin, proteins and albumin, CEA, and ASA grade, location and stage of tumour. The peri-operative dependent variables were: conversion, operating time and blood loss; and post-operative: local and general complications, need for intensive care, further surgery, hospital stay, and death. RESULTS: Group C had a higher incidence (P<.001) of arterial hypertension, diabetes mellitus, heart disease, chest disease and grade 3 ASA, as well as lower values for the Karnofsky Index, body mass index (BMI), haemoglobin, albumin and total protein. A higher incidence (P>.001) of general complications (respiratory and urinary), further surgery, admission to intensive care unit, longer hospital stay and death, was also observed in the post-operative period in this group. CONCLUSION: Although laparoscopic surgery offers advantages to patients over 80 years-old, this group has a higher risk of complications than the younger population and, as a result, we must take great care in their management.