Laparoscopic surgery after neoadjuvant therapy in elderly patients with rectal cancer.

PURPOSE: The standard treatment for mid or low locally advanced rectal cancer is neoadjuvant therapy followed by surgical resection. Laparoscopic surgery has recently been applied for the treatment of rectal cancer. However, few studies have reported the outcomes of laparoscopic surgery for elderly patients with rectal cancer after neoadjuvant therapy. This study aimed to investigate the short- and long-term outcomes of laparoscopic surgery for elderly patients with rectal cancer after neoadjuvant therapy.

METHODS: Patients received a total dose of 50.4 Gy over 5.5 weeks (45 Gy in 25 fractions to the pelvid and 5.4 Gy boost in 3 fractions to the primary tumor). Laparoscopic surgery for rectal cancer after neoadjuvant therapy was performed at our hospital on 89 elderly patients aged 75 years or older (the elderly group) from January 2008 to January 2016. Outcomes of the 89 patients were compared to those of 269 patients younger than 75 years enrolled during the same time period (the nonelderly group).

RESULTS: Compared with the nonelderly group, the Charlson comorbidity index (CCI) and American Society of Anesthesiologists (ASA) scores were higher in the elderly group. For short-term outcomes, there were no statistically significant differences. Differences between the two groups in the 5-year overall survival (OS) rate and 5-year disease-free survival (DFS) rate were not statistically significant.

CONCLUSION: Although the CCI was higher in elderly patients than in the nonelderly patients, laparoscopic surgery after neoadjuvant therapy was safe and effective in elderly patients with rectal cancer. Therefore, in the absence of any contraindications, laparoscopic surgery after neoadjuvant therapy is an appropriate treatment approach for elderly patients with rectal cancer.