Laparoscopic Surgery vs. Open Surgery for Older Patients with Rectal Cancer: A Comparative Study of Propensity Score

Abstract Background The purpose of this study was to compare the efficacy of laparoscopic surgery to open rectal cancer surgery in patients aged 70 years and older. Methods Consecutive patients (≥70 years old) who underwent rectal cancer surgery were retrospectively selected. Based on the covariates (age, gender, body mass index (BMI), ASA, TNM staging), the propensity score was calculated for paired comparison. The Tumor Distance from the Anal Verge (TDAV), history of abdominal surgery, combined diseases, time of operation, amount of blood loss, anastomosis method, postoperative hospital stay, time to first exhaust, time to first oral diet, postoperative complications, postoperative 30-day mortality and postoperative pathological staging of two groups were collected. Results Shorter operating time, higher intraoperative blood loss, slower intestinal function, longer time to first exhaust, longer postoperative hospital stay, higher incidence of postoperative complications (no statistical difference), and shorter duration of analgesics were observed in the OS group (all P<0.05). The sphincter preserving rate was basically the same in the two groups. For low rectal cancer with TDAV < 5 cm, more patients tended to choose LS (P=0.051); for middle rectal cancer with TDAV of 5-10 cm, more patients tended to choose OS (P=0.032). There was no significant difference in postoperative survival rate between the two groups. Conclusions In older patients, laparoscopic rectal cancer surgery led to less trauma, and a faster recovery compared to open surgery, with significant short-term advantages and no significant long-term advantages. For low rectal cancer, the advantage of LS was more prominent.