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

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.