Minimally Invasive Approach Aids Colon Cancer Care
The chance of ending up in a nursing facility appears to be significantly lower for older patients who undergo a laparoscopic procedure than for those who have open surgical resection for colon cancer, according to a study presented during a scientific poster session at the 2013 Clinical Congress of the American College of Surgeons. Investigators from Dalhousie University, Halifax, Nova Scotia, found that selected patients over the age of 70 were more likely to be discharged to their own homes—instead of a nursing facility—following laparoscopic operations when compared with patients who had a standard open surgical procedure, according to Richard Liu, MD, a resident in general surgery.
"There is evidence that laparoscopic surgical treatment for colon cancer is similar to an open operation in terms of outcomes from a cancer treatment point of view," Dr. Liu said. According to the National Cancer Institute, three-year survival and cancer recurrence rates are comparable for patients who have laparoscopic or open surgery for any stage of colon cancer. "Our study results show that patients who have the less invasive colon cancer operation are less likely to be discharged to a nursing home," Dr. Liu added.
The Dalhousie University surgeons reviewed data on all patients over the age of 70 years who had undergone colon cancer resection in the United States between 2009 and 2010. Data were obtained from the Nationwide Inpatient Sample (NIS) database. NIS is the largest registry of information about inpatient care. It includes information regarding eight million hospital stays in more than 1,000 hospitals. The NIS database revealed that 9,416 elderly patients had colon cancer operations: 5,704 had open surgical resection, and 3,712 had laparoscopic procedures. Among the patients who had open operations, 20 percent were discharged to a nursing facility. The likelihood of discharge to a nursing facility was significantly lower among the patients who had laparoscopic procedures. Only 12.5 percent of these patients were discharged to a nursing home.
The risk of discharge to a nursing facility was higher for some groups of patients, such as those who were markedly older than age 70. The patients with the lowest risk of discharge to a nursing facility were between the ages of 70 and 75. Patients between the ages of 75 and 80 were twice as likely to require nursing home follow-up care. Those between 80 and 85 were four times more likely and those over 85 were eight times more likely to end up in a nursing facility, Dr. Liu said. Patients who had major concomitant diseases, such as diabetes, hypertension, or heart disease, were more likely to need nursing home care.
Post-operative nursing home follow-up also was indicated for patients who had locally advanced colon cancer. "Colon cancer that has advanced outside the colon and invaded other structures makes the operation more difficult, and with more difficult operations, there may be more in-hospital complications, a longer length of stay, and other factors that may require post-operative nursing home care," Dr. Liu said. For patients in their early 70s who do not have advanced disease or significant comorbidities, laparoscopic colon cancer resection is an option not only to prolong survival but also to preserve quality of life, the authors concluded.
"Surgeons and researchers often focus on factors such as five-year survival rates and short-term morbidity and mortality. Sometimes we may forget about the patient's quality of life choices. Laparoscopic procedures for colon cancer are becoming a more prevalent option for all types of patients, and it should be considered particularly for the elderly because it may help them maintain the quality of life they desire," Dr. Liu said.