• Laparoscopy
• Obesity
• Rectal neoplasms

• Humans
• Rectal Neoplasms/surgery
• Rectal Neoplasms/mortality
• Rectal Neoplasms/complications
• Rectal Neoplasms/pathology
• Laparoscopy/methods
• Obesity/complications
• Aged
• Retrospective Studies
• Middle Aged
• Treatment Outcome
• Male
• Female
• Age Factors
• Disease-Free Survival
• Time Factors
• Length of Stay/statistics & numerical data
• Digestive System Surgical Procedures/methods
• Cohort Studies
• Aged, 80 and over
• Blood Loss, Surgical/statistics & numerical data
• Neoplasm Staging
• Adult
• Body Mass Index

• Colorectal cancer surgery
• Medicare advantage
• Medicare fee-for-service
• Minimally invasive surgery

• Humans
• United States
• Female
• Male
• Colorectal Neoplasms/surgery
• Colorectal Neoplasms/pathology
• Fee-for-Service Plans
• Aged
• Retrospective Studies
• Medicare Part C/statistics & numerical data
• Aged, 80 and over
• Laparoscopy/statistics & numerical data
• Laparoscopy/methods
• Robotic Surgical Procedures/statistics & numerical data
• Robotic Surgical Procedures/economics
• Length of Stay/statistics & numerical data
• Minimally Invasive Surgical Procedures/statistics & numerical data
• Patient Readmission/statistics & numerical data
• Colectomy/methods
• Colectomy/statistics & numerical data
• Colectomy/economics

• R01 MD016088 NIMHD NIH HHS
• R01MD016088 NIMHD NIH HHS
• National Institute on Minority Health and Health Disparities

• anastomotic leakage
• artificial intelligence
• colorectal cancer
• improved surgical management
• postoperative complications

• benign
• clinical guidelines
• colorectal surgery
• gastrointestinal symptoms

• United European Gastroenterology &European Society of Coloproctology Activity Grant

• Humans
• Aged
• Male
• Female
• Laparoscopy/methods
• Laparoscopy/economics
• Laparoscopy/statistics & numerical data
• Robotic Surgical Procedures/economics
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/statistics & numerical data
• Colorectal Neoplasms/surgery
• Retrospective Studies
• United States/epidemiology
• Propensity Score
• Postoperative Complications/epidemiology
• Aged, 80 and over
• Length of Stay/statistics & numerical data
• Hospital Costs/statistics & numerical data
• Colectomy/methods
• Colectomy/economics
• Treatment Outcome

• Colorectal surgery
• Hemodialysis
• Minimal invasive surgery
• Open surgery

• Humans
• Male
• Laparoscopy/adverse effects
• Female
• Renal Dialysis
• Colorectal Neoplasms/surgery
• Colorectal Neoplasms/mortality
• Middle Aged
• Retrospective Studies
• Aged
• Length of Stay
• Treatment Outcome
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Time Factors

• Aged
• Antineoplastic
• Capecitabine
• Fluoropyrimidines
• Geriatric oncology
• Treatment outcome

• Humans
• Aged
• Colorectal Neoplasms/drug therapy
• Chemotherapy, Adjuvant/adverse effects

• Extracorporeal anastomosis
• Intracorporeal anastomosis
• Laparoscopic
• Minimally invasive surgery
• Right colectomy
• Robotic surgery

• colorectal cancer
• complication
• laparoscopic-assisted colorectal surgery
• randomized controlled trial
• robot-assisted colorectal surgery

• colon neoplasms
• complication
• elderly
• obese
• prognosis

• Colorectal cancer
• Laparoscopy
• Meta-analysis
• Robotic surgical procedures

• Humans
• Flatulence/complications
• Flatulence/surgery
• Robotics
• Laparoscopy/adverse effects
• Lymph Nodes
• Colorectal Neoplasms/surgery
• Colorectal Neoplasms/complications
• Treatment Outcome
• Length of Stay
• Postoperative Complications/etiology
• Operative Time

With an ageing global population, we will see an increasing number of elderly patients with colorectal cancer (CRC) requiring surgery. However, it should be recognized that the elderly are a heterogenous group, with varying physiological and functional status. While traditionally viewed to be associated with frailty, comorbidities, and a higher risk of post operative morbidity, the advancements in minimally invasive surgery (MIS) and improvements in perioperative care have allowed CRC surgery to be safe and feasible in the elderly - chronological age alone should therefore not strictly be an exclusion criterion for curative surgery. However, as a form of MIS, laparoscopic assisted colorectal surgery (LACS) has the inherent disadvantages of: (1) Dependence on a trained assistant for retraction and laparoscope control; (2) The loss of wristed movement with reduced dexterity and suboptimal ergonomics; (3) A lack of intuitive movement due to the levering effect of trocars; and (4) An amplification of physiological tremors. Representing a technical evolution of LACS, robotic assisted colorectal surgery was introduced to overcome these limitations. In this minireview, we examine the evidence for robotic surgery in the elderly with CRC.

• Robotic surgery
• Minimally invasive surgery
• Colorectal cancer
• Elderly
• Geriatric
• Frailty

• Humans
• Aged
• Carcinoma, Hepatocellular/surgery
• Liver Neoplasms/surgery
• Hepatectomy
• Disease-Free Survival
• Laparoscopy
• Treatment Outcome
• Length of Stay
• Postoperative Complications/surgery
• Retrospective Studies
• Systematic Reviews as Topic
• Meta-Analysis as Topic

• advanced-age
• colorectal surgery
• laparoscopic
• postoperative paralytic ileus
• sarcopenia

• Ascending colon
• Colonic neoplasms
• Hemicolectomy
• Laparoscopic surgery
• Lymph node dissection

• cancer
• functional
• older adults
• outcomes
• surgery

• Aged
• Humans
• Frailty/epidemiology
• Frailty/etiology
• Frail Elderly
• Geriatric Assessment
• Retrospective Studies
• Risk Factors
• Neoplasms/epidemiology
• Neoplasms/surgery
• Ontario/epidemiology

• 419955 CIHR

• Laparoscopy
• laparoscopic proctectomy
• natural orifice specimen extraction (NOSE)
• natural orifice transluminal endoscopic surgery (NOTES)
• rectal cancer
• short-term outcome

• Humans
• Retrospective Studies
• Surgeons
• Rectal Neoplasms/surgery
• Minimally Invasive Surgical Procedures
• Laparoscopy

The purpose of this study was to evaluate outcomes in elderly patients (age ≥ 65 years) undergoing robotic colorectal surgery (RCRS) in comparison with non‐elderly patients.

Data was collected on elderly and non‐elderly patients who underwent RCRS from a prospectively maintained database.

A total of 89 elderly and 73 non‐elderly patients were identified. No statistically significant differences in postoperative complication, reoperation, wound infection, anastomotic leak or mortality were observed. The median length of stay was 1 day longer in elderly patients (p = 0.007). Subgroup analysis of octogenarians demonstrated outcomes that compared favourably with younger patients.

RCRS in elderly patients is safe and effective, with outcomes that do not differ significantly with younger patients. Older age should not be considered to be a specific exclusion criteria for RCRS. To our knowledge, this study represents the largest in the literature to examine outcomes specifically in elderly patients undergoing RCRS.

• colorectal cancer
• elderly
• laparoscopic surgery
• meta-analysis
• open surgery

• CR-POSSUM score
• colon diseases
• elderly patients
• emergency surgery
• postoperative course

• Aged
• Aged, 80 and over
• Colon/surgery
• Colorectal Surgery
• Digestive System Surgical Procedures/adverse effects
• Humans
• Intestinal Perforation/epidemiology
• Intestinal Perforation/etiology
• Intestinal Perforation/surgery
• Length of Stay
• Postoperative Complications/epidemiology

Colorectal cancer (CRC) resection is currently being undertaken in an increasing number of obese patients. Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery.

To evaluate the post-operative outcomes of obese patients following CRC resection, as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery.

Six-hundred and fifteen CRC patients who underwent surgery at the Prince Charles Hospital between January 2010 and December 2020 were categorized into two groups based on body mass index (BMI): Obese [BMI ≥ 30, n = 182 (29.6%)] and non-obese [BMI < 30, n = 433 (70.4%)]. Demographics, comorbidities, surgical features, and post-operative outcomes were compared between both groups. Post-operative outcomes were also compared between both groups in the subgroup of patients undergoing laparoscopic surgery [n = 472: BMI ≥ 30, n = 136 (28.8%); BMI < 30, n = 336 (71.2%)].

Obese patients had a higher burden of cardiac (73.1% vs 56.8%; P < 0.001) and respiratory comorbidities (37.4% vs 26.8%; P = 0.01). Obese patients were also more likely to undergo conversion to an open procedure (12.8% vs 5.1%; P = 0.002), but did not experience more post-operative complications (51.6% vs 44.1%; P = 0.06) or high-grade complications (19.2% vs 14.1%; P = 0.11). In the laparoscopic subgroup, however, obesity was associated with a higher prevalence of post-operative complications (47.8% vs 39.3%; P = 0.05) but not high-grade complications (17.6% vs 11.0%; P = 0.07).

Surgical resection of CRC in obese individuals is safe. A higher prevalence of post-operative complications in obese patients appears to only be in the context of laparoscopic surgery.

• Colorectal cancer
• Obesity
• Body mass index
• Post-operative outcomes
• Clavien-Dindo

Despite the growth of minimally invasive surgery (MIS) in many specialties, open colon surgery is still routinely performed. The purpose of this study was to compare outcomes and costs between open colon and minimally invasive colon resections.

We analyzed outcomes between January 1, 2016 and December31, 2018 using the Vizient® clinical database. Demographics, hospital length of stay, readmissions, complications, mortality, and costs were compared between patients undergoing elective open and minimally invasive colon resections. For bivariate analysis, Wilcoxon rank-sum test was used for continuous variables and χ² test was used for categorical variables. Multiple Logistic and Quintile regression were used for multivariable analyses.

A total of 88,405 elective colon resections (open: 56,599; minimally invasive: 31,806) were reviewed. A significantly larger proportion of patients undergoing minimally invasive surgery were obese (body mass index > 30) compared to those undergoing open surgery (71.4% vs. 59.6%; p < 0.0001). As compared to minimally invasive colectomy, open colectomy patients had: a longer median length of stay [median (range): 7 (4–13) days vs. 4 (3 – 6) days, p < 0.0001], higher 30-day readmission rate [n = 8557 (15.1%) vs. 2815 (8.9%), p < 0.0001], higher mortality [n = 2590 (4.4%) vs. 107 (0.34%), p < 0.0001], and a higher total direct cost [median (range): $13,582 (9041–23,094) vs. $9013 (6748 – 12,649), p < 0.0001]. Multivariable models confirmed these findings.

Minimally invasive colon surgery has clear benefits in terms of length of stay, readmission rate, mortality and cost, and the routine use of open colon resection should be revaluated.

• Colorectal surgery
• Laparoscopic
• Minimally invasive surgery
• Open approach
• Robotic

• cancer colorectal
• chirurgie
• colorectal cancer
• elderly
• sujet âgé
• surgery

• Aged
• Colorectal Neoplasms/surgery
• Humans
• Postoperative Complications

• cancer
• clinical trials
• frailty
• geriatrician
• older adults
• surgical oncologist

• Aged
• Geriatric Assessment
• Humans
• Medical Oncology
• Neoplasms/epidemiology
• Neoplasms/surgery
• Oncologists
• Surgeons

To assess the current approaches and perioperative treatments of laparoscopic right hemicolectomy (LRHC) and to highlight similarities and differences with international guidelines and scientific evidence, we conducted a survey for surgeons across the globe.

All digestive and colorectal surgeons registered with the database of the Research Institute against Digestive Cancer (IRCAD) were invited to take part in the survey via email and through the social media networks of IRCAD.

There were a total of 440 respondents from 78 countries. Most surgeons worked in the European region (38.6%) followed by the Americas (34.1%), the Eastern Mediterranean region (13.0%), the South-East Asian region (5.9%), the Western Pacific region (4.8%), and Africa (3.2%) respectively. Over half of the respondents performed less than 25% of right hemicolectomies laparoscopically where 4 ports are usually used by 68% of the surgeons. The medial-to-lateral, vessel-first approach is the approach most commonly used (74.1%). The most common extraction site was through a midline incision (53%) and an abdominal drain tube is routinely used by 52% of the surgeons after surgery. A total of 68.6% of the responding surgeons perform the majority of the anastomoses extracorporeally. Finally, we found that the majority of responders (60.7%) routinely used mechanical bowel preparations prior to LRHC.

Regarding several topics related to LRHC care, a discrepancy was observed between the current medical practice and the recommendations from RCTs and international guidelines and significant regional differences were observed.

The online version contains supplementary material available at 10.1007/s00464-022-09044-w.

• anastomotic leakage
• colorectal cancer
• risk factor

• Advanced Elderly
• Colonoscopy
• Colorectal Cancer
• Colorectal cancer screening
• Elderly
• Frailty

Surgical site infections (SSIs) are among the most common healthcare-associated infections. Evaluating risk factors for SSIs among patients undergoing laparoscopic and open colorectal resections can aid in selecting appropriate candidates for each modality.

A cohort of all consecutive patients undergoing elective colorectal resections during 2008–2017 in a single center was analyzed. SSIs were prospectively assessed by infection control personnel. Patient data were collected from electronic medical records. Risk factors for SSIs were compared between patients who underwent laparoscopic and open surgeries. A multivariate analysis was performed for significant variables.

During the study period, 865 patients underwent elective colorectal resection: 596 laparoscopic and 269 open surgeries. Mean age was 68.2 ± 15.1 years, weight 72.5 ± 18.3 kg and 441 (51%) were men. The most common indication for surgery was malignancy, in 767 patients (88.7%) with inflammatory bowel diseases and diverticulitis following (4.5% and 3.9%, respectively). Patients undergoing laparoscopic surgery were younger, had fewer comorbidities, shorter pre-operative hospitalizations, lower risk index scores, and lower rates of SSI, compared with open surgery. Independent risk factors for SSI following laparoscopic surgery were chronic obstructive pulmonary disease [odds ratio (OR) 2.655 95% CI (1.267, 5.565)], risk index ≥ 2 [OR 2.079, 95% CI (1.041,4.153)] and conversion of laparoscopic to open surgery [OR 2.056 95%CI (1.212, 3.486)]. Independent risk factors for SSI following open surgery were immunosuppression [OR 3.378 95% CI (1.071, 10.655)], chronic kidney disease [OR 2.643 95% CI (1.008, 6.933)], and need for a second dose of prophylactic antibiotics [OR 2.519 95%CI (1.074, 5.905)].

Risk factors for SSIs differ between laparoscopic and open colorectal resections. Knowledge of specific risk factors may inform patient selection for these modalities.

• Chronic obstructive pulmonary disease
• Colorectal surgery
• Laparoscopic
• Risk factors
• Surgical site infection

• colorectal cancer
• comprehensive geriatric assessment
• elderly
• frailty
• functional capacity
• geriatric liaison
• geriatric syndromes
• multicomponent programs

• Bowel resection
• Colorectal surgery
• Opioid antagonists
• Postoperative ileus
• Selective opioid antagonists

• Digestive System Surgical Procedures/adverse effects
• Female
• Humans
• Ileus/epidemiology
• Ileus/etiology
• Ileus/prevention & control
• Length of Stay
• Male
• Middle Aged
• Narcotic Antagonists
• Postoperative Complications/prevention & control

• Colorectal surgery
• Intraoperative barrier device
• Surgical site infection

This study aimed to analyse the perioperative results from a national dataset of rectal cancer resections in elderly patients.

The clinical records of patients undergoing rectal cancer surgery between 2012 and 2014 were retrieved from the Japanese National Clinical Database and analysed retrospectively. Patients were categorized according to age and those 80 years or older were defined as elderly. Subgroups were also defined according to the surgical approach (laparoscopy versus open surgery). The short-term outcomes, including mortality, anastomotic leak, surgical site infections and medical complications were compared between subgroups.

Of 56 175 patients undergoing rectal cancer surgery, some 6717 patients were elderly and laparoscopy was performed in 46.8 per cent of the sample. When comparing laparoscopy and open surgery in elderly patients, the operative mortality rate (1.5 versus 2.8 per cent; P < 0.001), the incidence of anastomotic leakage (5.2 versus 6.5 per cent; P = 0.026), surgical site infections (6.0 versus 8.0 per cent; P = 0.001), pneumonia (1.4 versus 2.5 per cent; P = 0.001), renal failure (0.7 versus 1.3 per cent; P = 0.016) and cardiac events (0.3 versus 0.8 per cent; P = 0.008) were lower for laparoscopy than for open surgery. The overall complication rate in elderly patients (19.5 per cent) was comparable to that in the younger group (P = 0.07). However, incidence of systemic complications was significantly higher in elderly than in younger patients (all P < 0.001).

Laparoscopy was safe and feasible in elderly patients compared with open surgery. However, the rates of systemic complications were significantly higher than in younger patients.

• Dependency
• Frailty
• Geriatric oncology
• Geriatric surgery
• Homecare
• Older adults
• Postoperative recovery

• Age Factors
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Frailty/complications
• Frailty/diagnosis
• Frailty/nursing
• Geriatric Assessment
• Home Care Services/statistics & numerical data
• Humans
• Male
• Neoplasms/complications
• Neoplasms/surgery
• Postoperative Care/statistics & numerical data
• Preoperative Period
• Retrospective Studies
• Time Factors

• Elderly
• Laparoscopy
• Postoperative complications
• Rectal cancer
• Short-term outcomes
• Surgery

A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1 ± 11.3, and mean BMI was 26 ± 5.5. Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5 ± 2, 2 grade of incontinence and the CS score showed an average of 10 ± 3, 2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients' great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure (47 ± 13 mmHg) and an increased volume to stimulate desire to defecate (197 ± 25 ml). The length of the anal sphincter was normal compared to the reference value (37 ± 5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.

Recently, colorectal cancer has increased in elderly patients worldwide, with laparoscopic colorectal surgery increasing in elderly patients with colorectal cancer. However, whether laparoscopic colorectal surgery is an optimal procedure for colorectal cancer in the elderly remains unclear. This study aimed to verify safety and curability of laparoscopic colorectal surgery in elderly patients ≥80 years old.

Patients undergoing curative colorectal surgery from 2006 to 2014 were enrolled and classified into the laparoscopic surgery in elderly patients aged ≥80 years (LAC-E) group, open surgery in elderly patients (OC-E) group, and laparoscopic surgery in non-elderly patients (LAC-NE) group. Short- and long-term outcomes were compared between these groups.

The LAC-E, OC-E, and LAC-NE groups comprised 85, 25, and 358 patients, respectively. Intraoperative blood loss and incidence of postoperative complications were significantly lower in the LAC-E versus OC-E group (97 vs. 440 mL, p < .01 and 14% vs. 32%, p < .05, respectively). Long-term outcomes were not different between these two groups. Operation time was significantly shorter in the LAC-E versus LAC-NE group (249 vs. 288 min, p < .01). Intraoperative blood loss and postoperative complications were similar between the groups. Although the 5-year overall survival rate in the LAC-E group was lower than that in the LAC-NE group (64% vs. 80%, p < .01), there was no difference in 5-year disease-specific survival between the groups.

Laparoscopic colorectal surgery is technically and oncologically safe for colorectal cancer in the elderly as well as the non-elderly and can be an optimal procedure for colorectal cancer in the elderly.

• Colorectal cancer
• Curability
• Elderly
• Laparoscopic surgery
• Safety

• colorectal cancer
• colorectal surgery
• frailty
• post-operative outcome

• Colonic neoplasms
• Diverticulitis
• Endometriosis
• Laparoscopic surgery
• Meta-analysis
• Natural orifice specimen extraction
• Rectal neoplasms

Multiple tools exist estimating perioperative risk. With an ageing surgical demographic, frailty is becoming an increasingly important concept in perioperative medicine due to its association with adverse post-operative outcomes. Reduced physical activity is a hallmark of frailty, and we postulate that a low pre-operative step count may be an objective measure of frailty. This study aimed to determine the association between low pre-operative step count and post-operative outcomes in patients undergoing elective colorectal cancer surgery.

A prospective analysis of 85 older patients undergoing major elective colorectal surgery was performed at a tertiary centre between October 2017 and October 2018. Patients aged 65 years and over who met inclusion criteria were provided with an activity tracker to wear for 14 days prior to planned surgery. Their median daily step count was measured and a cut-off of < 2500 steps/day was used to define a reduced step count. Primary outcomes included length of stay and 30-day post-operative complication rate. Multivariable logistic regression analyses were used to analyze the influence of low pre-operative step count and other preoperative variables, on post-operative outcomes including mortality, prolonged hospital admission, and complication rates.

Of 85 patients, 17 (20%) were identified as having a low pre-operative step count. A low pre-operative step count was associated with a significantly increased length of stay (14 vs. 6 days, IRR 2.09, 95% CI 1.55–2.83, p ≤ 0.01) and rate of major post-operative complications (29.4% vs. 8.8%, OR 3.34, 95% CI 1.03–14.3, p = 0.04). It was also associated with significantly increased rates of discharge to care facilities (p < 0.01) and requiring support on discharge (p = 0.03).

Low pre-operative step count (< 2500 steps/day) is predictive of an increased risk of post-operative morbidity in patients undergoing elective colorectal surgery. Accurate preoperative identification may allow for treatment modification and tailored perioperative care. The possibility of using a wearable activity tracker as a simple but powerful pre-habilitation tool is raised as an important avenue for future study.

Australian New Zealand Clinical Trials Registry (ACTRN12618000045213).

• Complications, Post-operative outcomes, Step-count
• Frail
• Pre-operative

• Colorectal cancer
• Ileostomy
• Incisional hernia

• Elderly
• Laparoscopy
• Outcomes
• Ventral hernia