Risk Factors for Severe Postoperative Complications After Laparoscopic Colorectal Cancer Surgery in Octogenarians: A Retrospective Cohort Study

Purpose: To evaluate the incidence and risk factors of severe postoperative complications in patients aged ≥ 80 years undergoing laparoscopic colorectal cancer surgery. Patients and Methods: Patients aged ≥ 80 years who underwent laparoscopic colorectal cancer surgery between February 2007 and September 2018. Severe complications were defined as Clavien–Dindo grade III or higher. Univariate and multivariate logistic regression analyses were performed to identify risk factors. Results: Among 170 patients, 26 (15.3%) experienced severe postoperative complications. Gastrointestinal events were most common (8.0%), followed by respiratory (3.5%) and cardiovascular (2.9%) complications. Two patients (1.2%) died postoperatively. Multivariate analysis identified estimated blood loss > 100 mL (OR = 4.53, 95% CI: 1.75– 11.70, P < 0.01) and age ≥ 85 years (OR = 4.48, 95% CI: 1.27– 15.79, P = 0.02) as independent risk factors. Hemoglobin < 120 g/L (OR = 2.56, 95% CI: 0.99– 6.60, P = 0.05) and ASA III (OR = 2.49, 95% CI: 0.98– 6.35, P = 0.06) showed borderline significance. Conclusion: Severe complications occurred in 15.3% of octogenarians undergoing laparoscopic colorectal cancer surgery. Age ≥ 85 years and intraoperative blood loss > 100 mL were independent risk factors. Preoperative anemia and ASA III were borderline predictors. These factors may aid in perioperative risk stratification and surgical decision-making in elderly patients.