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AUSTRALASIAN LAPAROSCOPIC COLON CANCER STUDY (ALCCAS): LOWER POSTOPERATIVE COMPLICATION RATES BENEFIT ELDERLY PATIENTS
Author(s) -
Allardyce R. A.,
Bagshaw P. F.,
Frizelle F. A.,
Hewett P. J.,
Rieger N. A.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04915_2.x
Subject(s) - medicine , complication , colorectal cancer , cancer , quality of life (healthcare) , surgery , randomized controlled trial , nursing
Purpose: We report the age‐related peri‐operative morbidity findings of the Australia and New Zealand prospective randomised controlled trial (RCT) comparing laparoscopic (LCR) and open (OCR) surgical treatments of right‐ and left‐sided, potentially curable, colon cancer. Methods: Between January 1998 and April 2005, 601 eligible patients were recruited by 33 surgeons from 31 Australian and New Zealand centres. Complications were analyzed by an independent reviewer. Their severity was classified as; mild, moderate or severe and their relatedness to surgery as; not, probably not, possibly or definitely. Results: 294 patients had LCR and 298 had OCR. 266 patients were < 70 and 326 ≥70 years (mean = 70.3 ± 11 years). There were 43 (14.6%) conversions from LCR to OCR, of which 35 (81%) had a complication. The numbers of surgical (p = 0.003) and medical (p = 0.043) complications were reduced in completed LCR operations when compared with OCR. These differences were attributable to significantly lower numbers of complications in patients ≥70 years (surgical, p = 0.002; medical, p = 0.043). Likewise, the numbers of individuals experiencing any complication favoured LCR treatment (p = 0.001) and specifically those ≥70 years (p = 0.004). Conclusion: Treatment choices for colon cancer depend upon survival and tumour recurrence, short‐term outcomes, costs and quality of life measures. If LCR is proven safe and affordable, our results suggest that patients ≥70 years with potentially curable colon cancer be rigorously investigated preoperatively to avoid conversions and then considered for LCR.