01 Sep 2011
By Ruth Loh
Laparascopic or keyhole colorectal surgery can benefit elderly patients with no increased risk of post-operative complications when compared to conventional open surgery, a study by Singapore General Hospital (SGH) has shown.
And if the patients are fit enough to undergo surgery, then the keyhole procedure - performed through tiny incisions with the aid of tiny cameras that magnify the surgical area on a viewing screen - should be offered to them as an option, the study said.
Dr Tan Wah Siew, Associate Consultant, Department of Colorectal Surgery, SGH, said: “What we found is that age is no barrier at all for this surgery. Our study found that patients who underwent laparoscopic surgery had better outcomes in terms of faster recovery, a shorter stay in hospital and less pain.”
The aim of the study, she said, was to prove that elderly patients with colorectal cancer can undergo laparoscopic surgery without a higher risk of complications and should be offered the benefit of having it. Researchers also wanted to examine concerns that older patients might have a higher risk of complications from the longer time under anaesthesia. Keyhole surgery takes slightly longer than conventional surgery as it is technically more intricate.
Dr Tan said: “Our numbers showed that elderly patients who went through this surgery didn’t come out with a higher complication rate than patients who had open surgery.”
More than 700 patients aged 70 to 95, who had both open and keyhole colorectal surgery, between from 2005 and 2008, were studied retrospectively. Although it was not a randomised study, the sheer numbers of patients involved in the study “made the results more likely to be accurate,” Dr Tan said.
Typically, and depending on complexity, conventional open surgery can take from half an hour to slightly over four hours, whereas keyhole surgery usually requires one to six hours, she added.
“But we found older patients were not compromised by this. (General anaesthetic-related) complications are mainly post-op. It seems there may be a higher risk related to keyhole surgery but we found there wasn’t. The rate of complications was similar, not higher,” she said.
Apart from a shorter convalescence, patients also needed less morphine for pain, so morphine-induced side effects such as nausea, vomiting, constipation, and problems urinating, were reduced.
Dr Tan describes keyhole surgery as “technically more difficult and more challenging than conventional open surgery” but said there are sufficient trained and experienced surgeons in SGH to be able to offer this surgery to any patient who wants it, and is suitable for it.
Not all patients are the same. “You can have a 90-year-old who is fit and another who is bed-bound and frail. But some patients should be offered it,” she said.
“The most important thing is safety. If this cannot be assured we won’t do it, or insist on it and put the patient’s life in danger. For example, if a tumour is too advanced, we may revert to performing open surgery.”
Keyhole surgery has been practised for 15 years and has become established in the last five.
The study took second place in the Best Oral Paper Award (Clinical) at SGH 19th Annual Scientific Meeting, held in April. Dr Tan led the team of doctors, mainly SGH’s Department of Colorectal Surgery, and from Yong Loo Lin School of Medicine, National University of Singapore.
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