be at even higher surgical risk than those who are obese or elderly.
1. Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: current status and implementation of the latest technological innovations. World J Gastroenterol. 2016;22:704–17.
2. Makino T, Shukla PJ, Rubino F, Milsom JW. The impact of obesity
on perioperative outcomes after laparoscopic colorectal resection.
Ann Surg. 2012;255:228–36.
3. Nguyen NT, Wolfe BM. The physiologic effects of pneumoperitoneum in the morbidly obese. Ann Surg. 2005;241:219–26.
4. Daskalakis M, Scheffel O, Weiner RA. High flow insufflation for the
maintenance of the pneumoperitoneum during bariatric surgery.
Obes Facts. 2009;2(Suppl 1):37–4 0.
5. Hoshino N, Fukui Y, Hida K, Sakai Y. Short-term outcomes of laparoscopic surgery for colorectal cancer in the elderly versus nonelderly: a systematic review and meta-analysis. Int J Colorectal Dis.
2019;34:377–86.
6. Marks JH, Kawun UB, Hamdan W, Marks G. Redefining contraindications to laparoscopic colorectal resection for high-risk patients.
Surg Endosc Other Interv Tech. 2008;22:1899–904.
7. Akagi T, Nakajima K, Hirano Y, Abe T, Inada R, Kono Y, et al. Laparoscopic
versus open resection for stage II/III rectal cancer in obese patients: a
multicenter propensity score-based analysis of short-and long-term
outcomes. Ann Gastroenterol Surg. 2023;7:71–80.
8. Geiger TM, Muldoon R. Complications following colon rectal surgery in the obese patient. Clin Colon Rectal Surg. 2011;24:274–82.
9. Itatani Y, Kawada K, Sakai Y. Treatment of elderly patients with colorectal cancer. Biomed Res Int. 2018;2018:2176056;2018:1–8.
10. Mustain WC, Davenport DL, Hourigan JS, Vargas HD. Obesity and
laparoscopic colectomy: outcomes from the ACS-NSQIP database.
Dis Colon Rectum. 2012;55:429–35.
11. Nugent TS, Kelly ME, Donlon NE, Fahy MR, Larkin JO, McCormick
PH, et al. Obesity and anastomotic leak rates in colorectal cancer: a
meta-analysis. Int J Colorectal Dis. 2021;36:1819–29.
12. Saito S, Akagi T, Katayama H, Wakabayashi M, Inomata M,
Yamamoto S, et al. Identification of patient subgroups with unfavorable long-term outcomes associated with laparoscopic surgery
in a randomized controlled trial comparing open and laparoscopic
surgery for colon cancer (Japan clinical oncology group study
JCOG0404). Ann Gastroenterol Surg. 2021;5:804–12.
Laparoscopic surgery tended to reduce postoperative complications without worsening the quality of surgery or the prognosis
in elderly obese patients when compared with nonelderly obese
patients. These findings suggest that laparoscopic surgery is a safe
and beneficial treatment option for colon cancer in elderly obese
patients.
The main strength of this study is that we were able to collect
cases from many hospitals specializing in colorectal cancer surgery,
which we believe eliminated any effect of bias introduced by the
experience of the surgeon. Laparoscopic surgery is more difficult in
obese patients, and studies that have failed to demonstrate a benefit of laparoscopic surgery in these patients have acknowledged
the problem of variable surgeon proficiency.30 Furthermore, we accounted for important clinical factors, including hypertension, diabetes, and cardiovascular, respiratory, and cerebral diseases, which
could have influenced our results. The main limitation of this research
is that the study population was Japanese, and the definition of obesity differs between Japan (BMI ≥25) and the West (BMI ≥30).31 In
addition, the results of this study are only applicable to patients with
special backgrounds because only obese patients were included in
this study. Therefore, the generalizability our findings to other populations may be limited.
5 | CONCLUSION
Laparoscopic surgery may be safely performed for colon cancer in
elderly obese patients without worsening their prognosis. There is
no difference in the effectiveness of laparoscopic surgery for colon
cancer between nonelderly and elderly obese patients.
24750328, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ags3.12678 by Cochrane Japan, Wiley Online Library on [27/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
763
HOSHINO et al.
13. Bell S, Kong JC, Wale R, Staples M, Oliva K, Wilkins S, et al. The
effect of increasing body mass index on laparoscopic surgery for
colon and rectal cancer. Colorectal Dis. 2018;20:778–88.
14. Singh A, Muthukumarasamy G, Pawa N, Riaz AA, Hendricks JB,
Motson RW. Laparoscopic colorectal cancer surgery in obese patients. Colorectal Dis. 2011;13:878–83.
15. Schwandner O, Farke S, Schiedeck TH, Bruch HP. Laparoscopic
colorectal surgery in obese and nonobese patients: do differences
in body mass indices lead to different outcomes? Surg Endosc.
2004;18:1452–6.
16. Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW,
Fazio CV. Laparoscopic colectomy in obese and nonobese patients.
J Gastrointest Surg. 2003;7:558–61.
17. Kazama K, Numata M, Aoyama T, Onodeara A, Hara K, Atsumi Y,
et al. Laparoscopic. In Vivo. 2020;34:2079–85.
18. Vignali A, De Nardi P, Ghirardelli L, Di Palo S, Staudacher C. Short
and long-term outcomes of laparoscopic colectomy in obese patients. World J Gastroenterol. 2013;19:7405–11.
19. Delaney CP, Pokala N, Senagore AJ, Casillas S, Kiran RP, Brady KM,
et al. Is laparoscopic colectomy applicable to patients with body
mass index >30? A case-matched comparative study with open colectomy. Dis Colon Rectum. 2005;48:975–81.
20. Holt PR, Kozuch P, Mewar S. Colon cancer and the elderly: from
screening to treatment in management of GI disease in the elderly.
Best Pract Res Clin Gastroenterol. 2009;23:889–907.
21. Millan M, Merino S, Caro A, Feliu F, Escuder J, Francesch T.
Treatment of colorectal cancer in the elderly. World J Gastrointest
Oncol. 2015;7:204–20.
22. Biondi A, Vacante M, Ambrosino I, Cristaldi E, Pietrapertosa G,
Basile F. Role of surgery for colorectal cancer in the elderly. World
J Gastrointest Surg. 2016;8:606–13.
23. Li S, Chi P, Lin H, Lu X, Huang Y. Long-term outcomes of laparoscopic surgery versus open resection for middle and lower rectal
cancer: an NTCLES study. Surg Endosc. 2011;25:3175–82.
24. Yue M, Wang Y, Kang ZH, Wang X, Wang L. Surgical and survival
outcomes of laparoscopic colectomy for trans-verse colon cancer in
elderly patients. J BUON. 2019;24:1852–60.
25. Fujii S, Ishibe A, Ota M, Yamagishi S, Watanabe K, Watanabe J,
et al. Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients. Surg
Endosc. 2014;28:466–76.
HOSHINO et al.
26. Grailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P, Faiz
O. Laparoscopic versus open colorectal resection in the elderly
population. Surg Endosc. 2013;27:19–3 0.
27. Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA.
Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients.
Surg Endosc. 2015;29:322–33.
28. Fujii S, Tsukamoto M, Fukushima Y, Shimada R, Okamoto K,
Tsuchiya T, et al. Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients. World J Gastrointest
Oncol. 2016;8:573–82.
29. Ishibe A, Ota M, Fujii S, Suwa Y, Suzuki S, Suwa H, et al. Midterm
follow-up of a randomized trial of open surgery versus laparoscopic
surgery in elderly patients with colorectal cancer. Surg Endosc.
2017;31:3890–7.
3 0. Choi BJ, Jeong WJ, Kim SJ, Lee SC. Impact of obesity on the short-
term outcomes of single-port laparoscopic colectomy for colorectal cancer in the Asian population: a retrospective cohort study.
Medicine (Baltimore). 2017;96:e6649.
31. Hotouras A, Ribas Y, Zakeri SA, Nunes QM, Murphy J, Bhan C, et al.
The influence of obesity and body mass index on the outcome of
laparoscopic colorectal surgery: a systematic literature review.
Colorectal Dis. 2016;18:O337–O66.
S U P P O R T I N G I N FO R M AT I O N
Additional supporting information can be found online in the
Supporting Information section at the end of this article.
How to cite this article: Hoshino N, Hida K, Fujita Y, Ohira
M, Ozawa H, Bando H, et al. Impact of laparoscopic surgery
on short-term and long-term outcomes in elderly obese
patients with colon cancer. Ann Gastroenterol Surg.
2023;7:757–764. https://doi.org/10.1002/ags3.12678
24750328, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ags3.12678 by Cochrane Japan, Wiley Online Library on [27/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
764 ...
論文の公開元へ
