Patients who had the less-invasive procedure were less likely to need nursing home care, study finds
TUESDAY, Oct. 8, 2013 (HealthDay News) -- Seniors who have minimally invasive laparoscopic surgery for colon cancer are much less likely to end up in a nursing home after being discharged from the hospital than those who have open surgery, a new study finds.
One expert not connected to the research said the study adds valuable information for patients.
"Laparoscopic surgery offers many advantages when compared to similar procedures performed through a large open incision," said Dr. Jerald Wishner, director of colorectal surgery at Northern Westchester Hospital in Mount Kisco, N.Y.
"Patients undergoing a laparoscopic approach experience less pain, earlier return of intestinal function, earlier ambulation [walking ability], shorter hospitals stays and earlier return to their baseline activities," he said. "These advantages can be particularly important to the elderly."
In the new study, a Canadian team of researchers reviewed data on more than 9,400 patients over the age of 70 who had colon cancer surgery in the United States between 2009 and 2010. Of those patients, more than 5,700 had open surgeries, while about 3,700 had less-invasive laparoscopic procedures.
Patients who had open surgery were much more likely than those who had laparoscopic surgery to be sent to a nursing home after leaving the hospital, the team found, at 20 percent versus 12.5 percent, respectively.
The study is scheduled for presentation Tuesday at the annual Clinical Congress of the American College of Surgeons in Washington, D.C. Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.
"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," study author Dr. Richard Liu, a general surgery resident at Dalhousie University in Halifax, Nova Scotia, said in a college news release.
According to the U.S. 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.
Age also affected the risk of ending up in a nursing home after colon cancer surgery. The lowest risk was for those aged 70 to 75, while the risk was four times higher among those aged 80 to 85 and eight times higher among those over 85, the researchers said.
Liu's team also found that patients who had other diseases -- such as diabetes, high blood pressure or heart disease -- were more likely to require nursing home care after leaving the hospital.
For colon cancer patients in their early 70s who do not have advanced cancer or other major health problems, laparoscopic surgery may help prolong their lives and also preserve their quality of life, the researchers concluded.
Wishner agreed. "The improvement in mobility and reduction in post-operative pain allows [patients] to leave the hospital sooner and without assistance, making them less likely to require discharge to a nursing home," he said. "In addition, early ambulation and the shorter hospital stay reduces the risk of post-operative complications such as pneumonia and venous thrombosis [blood clots], which would increase the need for longer-term care in a nursing home."
Another expert believes that laparoscopic colon surgery is still underused.
The procedure "is not new," said Dr. Julio Teixeira, a general surgeon specializing in minimally invasive surgery at Lenox Hill Hospital in New York City. "In fact, it was first done 20 years ago. However, the techniques had difficulty gaining acceptance among surgeons because of the concern over the safe and proper performance of cancer surgery and the challenging skill sets required."
Teixeira added that "ample evidence has now accumulated that minimally invasive surgery for colon cancer can be both safe and effective in treating the cancer. However, even most recent surveys show that only 15 to 20 percent of the nation's surgeons use laparoscopic techniques for colorectal surgery."
That's unfortunate, he said, since "the patients that stand to gain the most from minimally invasive surgery are often the weaker physiological reserve such as the elderly, the obese and those with significant problems such as pulmonary [lung] and cardiovascular disease."
The U.S. National Cancer Institute has more about colon cancer treatment (http://www.cancer.gov/cancertopics/pdq/treatment/colon/patient/ ).
SOURCES: Julio Teixeira, M.D., general surgeon, Lenox Hill Hospital, New York City; Jerald Wishner, M.D., director, colorectal surgery, Northern Westchester Hospital, Mount Kisco, N.Y.; American College of Surgeons, news release, Oct. 8, 2013