Robot-assisted surgery in elderly and very elderly population: our experience in oncologic and general surgery with literature review

Background Although there is no agreement on a defini- tion of elderly, commonly an age cutoff of C65 or 75 years is used. Nowadays most of malignancies requiring surgical treatment are diagnosed in old population. Comorbidities and frailty represent well-known problems during and after surgery in elderly patients. Minimally invasive surgery offers earlier postoperative mobilization, less blood loss, lower morbidity as well as reduction in hospital stay and as such represents an interesting and validated option for elderly population. Robot-assisted surgery is a recent improvement of conventional minimally invasive surgery. Aims We provided a complete review of old and very old patients undergoing robot-assisted surgery for oncologic and general surgery interventions. Patients and methods A retrospective review of all patients undergoing robot-assisted surgery in our General Surgery Unit from September 2012 to June 2016 was conducted. Analysis was performed for the entire cohort and in particular for three of the most performed surgeries & Aldo Rocca aldorocca@hotmail.it 1 Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy 2 (gastric resections, right colectomy, and liver resections) classifying patients into three age groups: B64, 65–79, and C80. Data from these three different age groups were compared and examined in respect of different outcomes: ASA score, comorbidities, oncologic outcomes, conversion rate, estimated blood loss, hospital stay, geriatric events, mortality, etc. Results Using our in-patient robotic surgery database, we retrospectively examined 363 patients, who underwent robot-assisted surgery for different diseases (402 different robotic procedures): colorectal surgery, upper GI, HPB, etc.; the oncologic procedures were 81%. Male were 56%. The mean age was 65.63 years (18–89). Patients aged C65 years represented 61% and C80 years 13%. Overall conversion rate was of 6%, most in the group 65–79 years (59% of all conversions). The more frequent diseases treated were colorectal surgery 43%, followed by hepato- bilopancreatic surgery 23.4%, upper gastro-intestinal 23.2%, and others 10.4%. Discussion Robot-assisted surgery is a safe and effective technique in aging patient population too. There was no increased risk of death or morbidity compared to younger patients in the three groups examined. A higher conversion rate was observed in our experience for patients aged 65–79. Prolonged operative time and in any cases steep positions (Trendelenburg) have not represented a problem for the majority of patients. Conclusions In any case, considering the high direct costs, minimally invasive robot-assisted surgery should be per- formed on a case-by-case basis, tailored to each patient with their specific histories and comorbidities.