Robotic surgery in elderly patients with colorectal cancer: Review of the current literature

Abstract

With an ageing global population, we will see an increasing number of elderly patients with colorectal cancer (CRC) requiring surgery. However, it should be recognized that the elderly are a heterogenous group, with varying physiological and functional status. While traditionally viewed to be associated with frailty, comorbidities, and a higher risk of post operative morbidity, the advancements in minimally invasive surgery (MIS) and improvements in perioperative care have allowed CRC surgery to be safe and feasible in the elderly - chronological age alone should therefore not strictly be an exclusion criterion for curative surgery. However, as a form of MIS, laparoscopic assisted colorectal surgery (LACS) has the inherent disadvantages of: (1) Dependence on a trained assistant for retraction and laparoscope control; (2) The loss of wristed movement with reduced dexterity and suboptimal ergonomics; (3) A lack of intuitive movement due to the levering effect of trocars; and (4) An amplification of physiological tremors. Representing a technical evolution of LACS, robotic assisted colorectal surgery was introduced to overcome these limitations. In this minireview, we examine the evidence for robotic surgery in the elderly with CRC.

Keywords: Robotic surgery; Minimally invasive surgery; Colorectal cancer; Elderly; Geriatric; Frailty

Core Tip: Robotic assisted colorectal surgery (RACS) is safe and feasible in the elderly. Despite an increased operative time, it potentially confers the benefit of lower conversion, earlier return of gut function and shorter length of stay with comparable oncological outcomes. As such, age alone should not be a specific exclusion criterion for RACS.