Factors affecting the selection of minimally invasive surgery for stage 0/I colorectal cancer

Abstract

PURPOSE: To evaluate which factors affect selection of minimally invasive surgery (MIS) or open procedures for patients with stage 0/I colorectal cancer. The short-term and oncologic outcomes of MIS were also compared to those of open procedures. METHODS: A total of 181 consecutive patients underwent either MIS (laparoscopy: n = 146, robot: n = 8) or open (n = 27) colorectal resection for stage 0/I disease. RESULTS: Elderly patients (≥80) were more common in the open procedure group (22.2%) than the MIS (7.8%) group (p = .02). Surgeon A performed more MIS procedures than surgeon B (p = .003). There were no differences in the 30-day complication rate between open (37%) and MIS (21.4%) groups (p = .08). Time to tolerable diet (p = .002) and length of hospital stay (p = .02) were shorter in the MIS group. There were no differences in the cancer-specific survival (p = .71) and recurrence-free survival rates (p = .67) between open and MIS procedures. CONCLUSIONS: Patient factors (old age) and surgeon factors (surgeon B) were barriers to the choice of MIS. Old age and operating surgeons were not associated with adverse 30-day complications. The short-term and oncologic outcomes of MIS were comparable to those of open procedures. It is safe to expand the indication for MIS to elderly patients.