Meta-Analysis
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World J Gastroenterol. Dec 14, 2014; 20(46): 17626-17634
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17626
Meta-analysis of laparoscopic vs open cholecystectomy in elderly patients
Stavros A Antoniou, George A Antoniou, Oliver O Koch, Rudolph Pointner, Frank A Granderath
Stavros A Antoniou, Frank A Granderath, Center for Minimally Invasive Surgery, Hospital Neuwerk, 41066 Mönchengladbach, Germany
Stavros A Antoniou, Department of General Surgery, University General Hospital of Heraklion, 71500 Crete, Greece
George A Antoniou, Department of Vascular Surgery, Red Cross Hospital, 11526 Athens, Greece
Oliver O Koch, Department of General and Visceral Surgery, Sisters of Charity Hospital, 4020 Linz, Austria
Rudolph Pointner, Department of General and Visceral Surgery, Hospital Zell am See, 5700 Zell am See, Austria
Author contributions: Antoniou SA and Antoniou GA designed the research; Antoniou SA, Antoniou GA and Koch OO performed the research; Antoniou SA, Pointner R and Granderath FA analyzed the data; Antoniou SA and Antoniou GA wrote the paper.
Correspondence to: Stavros A Antoniou, MD, PhD, Center for Minimally Invasive Surgery, Hospital Neuwerk, Dünner Str. 214-216, 41066 Mönchengladbach, Germany. stavros.antoniou@hotmail.com
Telephone: +30-6978-732791 Fax: +49-1638-518279
Received: December 26, 2013
Revised: January 21, 2014
Accepted: June 14, 2014
Published online: December 14, 2014
Processing time: 356 Days and 17.9 Hours
Abstract

AIM: To investigate the comparative effect of laparoscopic and open cholecystectomy in elderly patients.

METHODS: Laparoscopic cholecystectomy has induced a revolution in the treatment of gallbladder disease. Nevertheless, surgeons have been reluctant to implement the concepts of minimally invasive surgery in older patients. A systematic review of Medline was embarked on, up to June 2013. Studies which provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open cholecystectomy were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was appraised using valid assessment tools. Τhe random-effects model was applied to synthesize outcome data.

RESULTS: Out of a total of 337 records, thirteen articles (2 randomized and 11 observational studies) reporting on the outcome of 101559 patients (48195 in the laparoscopic and 53364 in the open treatment group, respectively) were identified. Odds ratios (OR) were constantly in favor of laparoscopic surgery, in terms of mortality (1.0% vs 4.4%, OR = 0.24, 95%CI: 0.17-0.35, P < 0.00001), morbidity (11.5% vs 21.3%, OR = 0.44, 95%CI: 0.33-0.59, P < 0.00001), cardiac (0.6% vs 1.2%, OR = 0.55, 95%CI: 0.38-0.80, P = 0.002) and respiratory complications (2.8% vs 5.0%, OR = 0.55, 95%CI: 0.51-0.60, P < 0.00001). Critical analysis of solid study data, demonstrated a trend towards improved outcomes for the laparoscopic concept, when adjusted for age and co-morbid diseases.

CONCLUSION: Further high-quality evidence is necessary to draw definite conclusions, although best-available evidence supports the selective use of laparoscopy in this patient population.

Keywords: Laparoscopic; Open cholecystectomy; Surgery; Elderly; Older; Geriatric; Complications; Mortality; Morbidity

Core tip: This systematic review and meta-analysis investigates the comparative effect of laparoscopic and open cholecystectomy in elderly patients. Critical analysis of solid study data, demonstrated a trend towards improved outcomes for the laparoscopic concept, when adjusted for age and co-morbid diseases. Current data do not definitively support the use of laparoscopic or open cholecystectomy on older patients. Further high-quality evidence is necessary to draw definite conclusions, although best-available evidence supports the elective use of laparoscopy in this patient population.