Patients with colorectal or bladder cancer may benefit from advanced surgical approaches

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Octogenarians with bladder or colorectal cancer may benefit from advanced surgical techniques such as robotic-assisted operations and minimally invasive surgical procedures. These techniques may extend survival and improve recovery compared with patients who undergo conventional open operations.

Robotic-assisted bladder procedures may be a viable option in selected patients age 80 years and older who would not otherwise have an operation to remove the cancer. Older people are disproportionately affected by colon, rectal, and bladder cancers. For bladder cancer, the median age at diagnosis is 73 years, and the median age at death is 79 years.

The records of 17 patients aged 80 to 88 years who underwent robotic-assisted cystectomy operations to remove their bladders were studied. The average postoperative hospital stay was 7 days, only three complications were reported within the first 90 days after surgery, and none of the patients died from surgical complications. Vikrant Uberoi, MD, a urology resident at Boston University, explained that, “The standard of care for muscle-invasive bladder cancer is to undergo cystectomy.” However, he explained, patients older than 80 years were not being offered cystectomy; they were more likely to be treated with alternatives such as chemotherapy and radiation because of their age and comorbidities.

Laparoscopic operations for colon and rectal cancers in the elderly were investigated by examining the records of 216 patients. The patients were evenly divided between laparoscopic and open operations over a 6.5-year period from 2004 to 2010. For colon and rectal cancers, the median age at diagnosis is 73 years, and the median age at death is 79 years.

“Our study results showed the laparoscopic patient group lived a median of 2 years longer than the group that had open surgery,” reported Therese Gannon Kerwel, MD, fellow in colorectal surgery at Spectrum Health, Grand Rapids, Michigan. “The laparoscopic group was also much more likely to undergo chemotherapy in stage III disease. Given that the average age in our study was 81.5 years, the laparoscopic approach for colorectal cancer patients revealed a significant survival benefit.”

The standard of care for stage III colorectal cancer involves two phases of treatment: removing the tumor via a surgical resection, and then treating the affected area with a course of chemotherapy. However, Kerwel explained that, for many patients older than 75 years, the surgery to remove the tumor leaves them too frail for chemotherapy to be started in a timely manner.

Overall, nearly 60% of the patients in the laparoscopic group were disease-free and alive 5 years after the operation, compared with 40% of the open-surgery group. Kerwel stated that the better survival in the laparoscopic group may be explained because 63% of the laparoscopic group went on to chemotherapy, while only 29% of the open surgery group did.

These two studies were presented at the 2012 Annual Clinical Congress of the American College of Surgeons.
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