Table 1.
Study and patient characteristics (original studies included in this review)
| Original study | Country and setting | Study-design | Population | Sample | Age median (range) or mean (±SD), in y | Inclusion criteria (original study) |
Exclusion criteria (original study) |
|---|---|---|---|---|---|---|---|
| Zeng 2017 [16] |
China Monocentric, academic |
Database analysis |
Colorectal Laparoscopic Cancer |
94 ERP ≥ 75y 157 CC ≥75y |
78 (75–88) 78 (75–90) |
≥75y Laparoscopic colorectal surgery Colorectal cancer |
Emergency surgery Non-radical resection TNM stage IV Multi-organ resection |
| Pirrera 2017 [17] |
Italy Monocentric, non-academic |
Database analysis |
Colorectal Laparoscopic Cancer/Benign |
203 ERP > 75y 175 ERP 66-75y 211 ERP ≤65y |
80 (range NR) 69 (range NR) 56 (range NR) |
Colorectal resection Scheduled for laparoscopic approach |
Emergency surgery Palliative procedure |
| Forsmo 2017 [18] |
Norway Monocentric, academic |
Secondary analysis of RCT data |
Colorectal Open/Lap Cancer/Benign |
19 ERP ≥ 80y 56 ERP 66-79y 79 ERP ≤ 65y |
83 (80–89) 72 (66–78) 58 (23–65) |
≥18y Colorectal surgery With or without stoma Malignant or benign |
Multi-organ resection ASA 4 Emergency surgery Impaired mental capacity |
| Braga 2017 [19] |
Peri-operative Italian Society Registry (11 hospitals) |
Database analysis |
Colorectal Open/Lap Cancer/Benign |
93 ERP > 80 y 117 ERP 76-80y 105 ERP 71-75y |
84 (SD ± 3) 77 (SD ± 2) 73 (SD ± 1) |
>70y Elective colorectal surgery |
/ |
| Braga 2016 [20] |
Peri-operative Italian Society Registry (11 hospitals) |
Database analysis |
Colorectal Open/Lap Cancer/Benign |
167 ERP ≥ 70y, ASA 1–2 162 ERP ≥ 70y, ASA 3–4 279 ERP <70y, ASA 1–2 98 ERP <70y, ASA 3–4 |
77 (SD ± 4.6) 78 (SD ± 5.3) 58 (SD ±9) 63 (SD ±5.7) |
Elective colorectal surgery | / |
| Gonzalez-Ayora 2016 [21] |
Spain Multicentric, academic |
Database analysis |
Colorectal Open/Lap Cancer/Benign |
188 ERP ≥ 70y | 79 (70–93) |
≥70y Colorectal surgery |
Emergency surgery Palliative procedure |
| Pedziwiatr 2015 [22] |
Poland Monocentric, academic |
Database analysis |
Colorectal Laparoscopic Cancer |
34 ERP ≥ 80y 43 ERP ≤55y |
83 (IQR 82–87) 50 (IQR 44–54) |
≥80y or ≤ 55y Laparoscopic colorectal surgery Colorectal adenocarcinoma |
Emergency surgery Multi-organ or transanal resection Concomitant IBD ICU stay after surgery |
| Kisialeuski 2015 [23] |
Poland Monocentric, academic |
Prospective observational cohort study |
Colorectal Laparoscopic Cancer |
49 ERP > 65y 43 ERP ≤65y |
76.3 (SD NR) 55.8 (SD NR) |
Laparoscopic colorectal surgery Colorectal cancer |
Emergency surgery Multi-organ resection |
| Jia 2014 [24] |
China Monocentric, academic |
RCT |
Colorectal Open Cancer |
117 ERP ≥ 70y 116 CC ≥70y |
75.7 (SD ± 4.2) 74.8 (SD ±4.0) |
≥70y Admitted for open curative resection Colorectal carcinoma |
Dementia, Parkinson, alcohol intake ≥250 g/d, long term sleeping pills or anxiolytics, anaesthesia ≤30d Intra-operative blood transfusion or ICU stay after surgery |
|
Keller 2013 [25] |
USA Monocentric, academic |
Database analysis |
Colonic Laparoscopic Cancer/Benign |
153 ERP ≥ 70y 302 ERP <70y |
77.9 (SD ± 6.1) 52.4 (SD ±13.7) |
Elective laparoscopic colon resection (conversions included) | Incomplete medical or financial records |
| Feroci 2013 [26] |
Italy Monocentric, non-academic |
Database analysis |
Colorectal Open/Lap Cancer/Benign |
204 ERP ≥ 75y 402 ERP <75y |
Overall: 70 (30–94) |
Elective colorectal resection (multiple previous laparotomies are included) ASA grades 1 to 4 |
Medically unfit for surgery Cancer with distant metastasis <18y or pregnant |
| Baek 2013 [27] |
Korea Monocentric, academic |
Prospective observational cohort study |
Colorectal Laparoscopic Cancer |
77 ERP ≥ 70y 226 ERP <70y |
74.8 (SD ± 4.2) 56.7 (SD ±8.9) |
Laparoscopic or robotic surgery Colorectal cancer |
Emergency surgery ASA 4 ICU stay after surgery Conversion (laparoscopic to open) |
| Wang 2012 [28] |
China Monocentric, academic |
RCT |
Colorectal Laparoscopic Cancer |
40 ERP ≥ 65y 38 CC ≥65y |
71 (65–81) 72 (65–82) |
≥ 65y Laparoscopic colorectal resection Colorectal cancer |
Distant metastasis (involving pelvic, urethra of iliac vessel invasion) Poor cardiopulmonary function |
| Pawa 2012 [29] |
UK Monocentric, academic |
Database analysis |
Colorectal Open/Lap Cancer/Benign |
130 ERP ≥ 80y 558 ERP < 80y |
83 (80–95) 66 (17–79) |
Colorectal resection | None |
| Walter 2011 [30] |
UK Monocentric, non-academic |
Database analysis; retrospective control group |
Colorectal Open/Lap Cancer/Benign |
68 ERP ≥ 80y 332 ERP < 80y 200 CC |
Overall: 67 (IQR 56–77) 69 (IQR 57–78) |
Major colorectal resections First 400 consecutive, non-selected, patients managed within an ERP Last 200 patients pre-ERP |
Emergency surgery |
| Kahokehr 2011 [31] |
New Zealand Monocentric, academic |
Prospective observational cohort study |
Colonic Open/Lap Cancer/Benign |
22 ERP > 75y 78 ERP ≤75y |
Overall: 67.5 (IQR 31–92) |
Elective colonic surgery within an ERP | Rectal cancer ≤15 cm from the anal verge, patients requiring a stoma or unable to participate (language, cognitive impairment, ASA ≥4) |
| Rumstadt 2009 [32] |
Germany FTCII programme (24 hospitals) |
Database analysis |
Colonic Open/Lap Cancer/Benign |
207 ERP ≥ 80y 535 ERP 70-79y |
74.7 (70–79.9) 83.4 (80–95.7) |
≥ 70y Elective colonic resection |
Emergency surgery Perforation or abscess with septic inflammatory response syndrome |
| Hendry 2009 [33] |
UK, Norway, Sweden, The Netherlands Multicentric, academic |
Database analysis |
Colorectal Open Cancer/Benign |
194 ERP ≥ 80y 839 ERP <80 |
Overall: 59 (IQR 69–78) |
Elective open colorectal surgery with formation of an anastomosis In case of rectal cancer: tumour in the upper 1/3 of the rectum and allows anastomosis in the middle 1/3 ASA grade 1 to 4 |
Total mesorectal excision |
| Scharfen-berg 2007 [34] |
Germany Monocentric, academic |
Prospective observational cohort study |
Colonic Open/Lap Cancer/Benign |
74 ERP > 70y | 74 (71–88) |
> 70y Elective colonic resection Benign or malignant disease |
Not operated on electively |
| Senagore 2003 [35] |
USA Monocentric, academic |
Retrospective observational cohort study |
Colonic Open/Lap Cancer/Benign |
50 ERP ≥ 70y, lap 123 ERP ≥ 70y, open 181 ERP <60y, lap 122 ERP <60y, open |
77.5 (SE ± 4.6) 77.8 (SE ± 5.4) 42.4 (SE ±12.3) 46.7 (SE ±9.8) |
4 age-matched cohorts Elective segmental colectomy Laparoscopic/open when excluded for laparoscopic approach based on standardised criteria |
Prior major abdominal surgery Incomplete data |
| Bardram 2000 [36] |
Denmark Monocentric, academic |
Retrospective observational cohort study |
Colonic Laparoscopic Cancer/Benign |
39 ERP ≥ 70y, lap 11 ERP ≥70y, converted |
Overall: 81 (70–93) |
Laparoscopic colonic resection Laparoscopic surgery 70–75y: benign disease or malignant disease with severe cardiopulmonary disease > 75y: malignant disease |
Not elective Tumours in the transverse colon or rectum Patients not self-caring and not admitted directly from home |
LEGEND: RCT randomised controlled trial, ERP enhanced recovery programme, CC conventional care, vs versus, y years old, g gram, d day, lap laparoscopic, SD standard deviation, SE standard error of the mean, NR not reported, TNM tumour node metastasis, ASA American society of anaesthesiologists physical status class, IBD inflammatory bowel disease, ICU intensive care unit, FTCII fast track colon II open quality assurance programme; Bold: patient group included in this review